Proximal gastric vagotomy and mucosal antrectomy: a possible operative approach to duodenal ulcer

Our aim was to develop proximal gastric vagotomy with mucosal antrectomy as an operative approach to duodenal ulcer. We performed mucosal antrectomy in four dogs by excising the antral mucosa via a circular corporal myotomy, removing a circumferential band of corporal seromuscularis, anastomosing the corporal and pyloric mucosas endoantrally, and reapproximating the corporal and antral seromuscularis. Gastric emptying and serum gastrin were assessed before and 4 weeks after operation. A second operation, proximal gastric vagotomy, was then done, and the tests were repeated 4 weeks later. The concentration of gastrin in the serum during fasting was lower after mucosal antrectomy than before operation, as was the postprandial concentration; the values remained low after proximal gastric vagotomy. Gastric emptying of liquids and indigestible solids was unaltered by mucosal antrectomy or mucosal antrectomy plus proximal gastric vagotomy. The emptying of digestible solids was slowed somewhat by mucosal antrectomy to 75% of the control rate, but no further change was found after proximal gastric vagotomy. We concluded that mucosal antrectomy eliminated the gastrin-producing antral mucosa and, in combination with proximal gastric vagotomy, did not greatly alter gastric emptying of liquids or solids. The combined operation might have a role in the surgical treatment of duodenal ulcer.