[The effect of proximal-selective vagotomy in gastroduodenal ulcer]

In a recently concluded prospective multicenter trial, pyloric (PU) and prepyloric (PPU) ulcers showed a significantly higher recurrence rate after proximal gastric vagotomy (PGV) without drainage than duodenal (DU) or gastric ulcers (GU). The secretory pattern of the PU and PPU cannot explain the failure of PGV. However, PU and PPU (and some GU) exhibit a distinct and probably irreversible alteration of the muscular layer at the pylorus and distal antrum. This could be one factor which helps to explain the failure of vagotomy alone in these ulcer types. To deal with this antropyloric distrophy, addition of drainage or antrectomy to PGV must be considered. A refined concept for surgical treatment of peptic ulcer is proposed.