Prospective trial of proximal gastric vagotomy

Forty men who were to have elective operation for nonobstructive duodenal or pyloric channel ulcer were randomized prospectively to undergo either proximal gastric vagotomy without drainage (PGV, n = 18) or selective vagotomy, antrectomy, and gastroduodenostomy (SVA, n = 22). Gastric acid analyses were accomplished before and 3 and 12 months after operation. Clinical interviews were conducted yearly. Thirty-nine patients were evaluable at 2 years, 25 at 4 years, and 15 at 5 years. No operative deaths occurred. Recovery was more rapid and the incidence of serious operative morbidity was lower after PGV than after SVA. Reduction of basal and stimulated gastric secretion was greater after SVA than PGV. Significant long-term sequelae other than recurrent ulcer were less frequent after PGV compared to SVA. Recurrent ulcer may occur more often after PGV; 3-month gastric secretory studies may be helpful in anticipating recurrence. Patients who undergo PGV have a particularly increased risk of developing pyloric channel ulcer disease, and low secretory values indicating an adequate vagotomy do not assure future protection from pyloric channel ulcer recurrence. Long-term sequelae after SVA, particularly dumping, do not have dependable reoperative options, whereas antrectomy should be a reliable reoperative solution to ulcer recurrence after PGV. PGV, performed correctly with a 5 to 7 cm vagal-esophageal separation, is preferable to vagotomy and resection for elective treatment of nonobstructing duodenal ulcer disease.