Controlled trial of the Grassi (pH) intraoperative test for completion of proximal gastric vagotomy

Forty-eight patients undergoing PGV for duodenal ulcer were randomized to Grassi test (24) or no test (24). Operations were performed by surgeons who were Fellows of the Royal College of Surgeons trained in the technique of PGV and every effort was made to complete the vagotomy if the test was positive. Patients were assessed by standard pentagastrin test preoperatively and postoperatively. The two groups were closely matched for age (Grassi 48, non-Grassi 43), sex (Grassi 20 males; non-Grassi, 21 males), preoperative BAO (6.4 +/- 1.2 S.E.M. millimols hydrogen ions per hour and 6.6 +/- 0.9 S.E.M. millimols hydrogen ions per hour) and preoperative PAO (45.5 +/- 2.1 S.E.M. millimols hydrogen ions per hour and 40.5 +/- 2.6 S.E.M. millimols hydrogen ions per hour). Postoperatively, the BAO was 1.2 +/- 0.4 S.E.M. millimols hydrogen ions per hour for the Grassi group and 0.8 +/- 0.2 S.E.M. millimol hydrogen ions per hour. The postoperative PAO (pg) for the Grassi group was 19.1 +/- 0.9 S.E.M. millimols hydrogen ions per hour and for the non-Grassi group, it was 19.5 +/- 1.9 S.E.M. millimols hydrogen ions per hour. The mean reduction in PAO (pg) were 57.0 +/- 4.3 per cent for the Grassi group and 51 +/- 4 per cent for the non-Grassi group, but two patients in the non-Grassi group had a reduction of less than 10 per cent, one of whom has had recurrent symptoms at three months. Eight Grassi and four non-Grassi patients had reductions of greater than 65 per cent. The mean operating was 110.0 +/- 6.8 minutes for the Grassi patients and 87.0 +/- 3.1 for the non-Grassi patients.