Vagotomy or gastrectomy for gastric ulcer

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Surgery

Background:

• Benign gastric ulcers are common, with surgical management options including partial gastrectomy and vagotomy with pyloroplasty.
• Long-term functional outcomes and complication rates of these procedures require further comparative analysis.

Purpose of the Study:

• To compare the long-term functional results and complication rates of Billroth I partial gastrectomy versus vagotomy and pyloroplasty for benign gastric ulcers.
• To assess the need for reoperation after each surgical approach.

Main Methods:

• A randomized controlled trial involving 100 patients (50 per group) with benign gastric ulcers of the stomach body.
• Follow-up period of approximately five years (1.5 to 8.5 years).
• Assessment of functional outcomes using Visick grading, operative mortality, postoperative morbidity, and length of hospital stay.

Main Results:

• No statistically significant difference in functional results (Visick grading) between the two groups.
• Operative mortality was zero for both procedures.
• Postoperative morbidity and length of hospital stay were significantly higher after gastrectomy compared to vagotomy and pyloroplasty.
• Seven patients (14%) undergoing vagotomy and pyloroplasty required reoperation (gastrectomy) for recurrent ulceration, gastric cancer, or bleeding, a statistically significant excess compared to the gastrectomy group.

Conclusions:

• Both Billroth I partial gastrectomy and vagotomy with pyloroplasty offer comparable long-term functional outcomes for benign gastric ulcers.
• Vagotomy and pyloroplasty may be considered to avoid technically challenging gastrectomies.
• However, the higher rate of reoperation after vagotomy and pyloroplasty indicates it cannot fully replace partial gastrectomy in managing gastric ulcers.