A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty--one surgeon's results after 5 years

In a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety-eight per cent of patients were reviewed by two physicians after 20-97 mth (mean 61 mth). Fifty-nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P less than 0.05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P less than 0.001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P less than 0.001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P less than 0.001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P less than 0.05). HSV gave better results than TVP and was associated with a low recurrence rate (1.5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duodenal ulcer.