Long-term results of proximal gastric vagotomy

Proximal gastric vagotomy without drainage for duodenal ulcer was performed in 304 patients between 1969 and 1977. There was one operative death (0.3%) and two patients required secondary drainage (0.6%). Eleven patients died subsequently of unrelated causes. Follow-up 5 to 13 years after operation was conducted on 242 patients (80%). Of these, 141 were asymptomatic and 48 had only trivial symptoms, a success rate of 78%. Thirty-two patients had recurrent ulcer and 2 of them had Zollinger-Ellison syndrome. When these two were excluded, the recurrence rate was 12.4%. Two patients had duodenitis. Seven patients had unexplained pain and some of them may ultimately be shown to have recurrence. Appreciable esophageal reflux was seen in eight patients. Other symptoms, nearly all mild, were dumping in one, diarrhea in seven and bile reflux in six. Recurrent ulcer was treated by cimetidine initially in all 32 cases but ultimately by repeat vagotomy and antrectomy in 27, with no deaths and only one further recurrence (Zollinger-Ellison syndrome). After operative correction, the ultimate success rate (Visick grades I and II) was 90%.