A porspective study of parietal cell vagotomy and selective vagotomy-antrectomy for treatment of duodenal ulcer

Abstract

A prospective, randomized, study involving 92 patients who required elective operation for treatment of duodenal ulcer was performed to compare the results of Parietal Cell Vagotomy (PCV) and selective vagotomy-antrectomy Billroth I (SV-A-BI). The protocol was broken twice. One patient was unable to undergo PCV because of pyloric stenosis and one patients underwent Billroth II anastomosis instead of Billroth I because of post-bulbar stenosis. Performance of PCV was never aborted because a patient was obese. There were no deaths. Diarrhea, dumping and other gastric complaints were less frequent after PCV than after SV-A-BI for all time periods studies up to two years. Two months after operation, the Hollander tests were negative in 59% of patients after PCV and in 100% after SV-ABI. Inhibition of Bao and MAO were also significantly less after PCV than after SV-A-BI. Since vagotomy of the parietal cell mass was identical in both groups of patients it was concluded that the differences in the secretory rates and the fewer negative Hollander tests in the PCV group than in the SV-A-BI group were due to retention of the antrum irrespective of its innervation. There was no explanation for the gradual increase in the BAO in the PCV group. One recurrent ulcer occurred in the PCV group in a patient who overindulged in alcohol and aspirin. After 4 days of medical management, this superficial ulcer healed as demonstrated by endoscopy. There were no recurrent ulcers after SV-A-BI. As a result of this study, it is concluded that PCV is superior to SV-A-BI because of the lower frequency of postoperative complications, diarrhea, dumping and other symptoms associated with gastric surgery. PCV may be the operation of choice for the elective treatment of duodenal ulcer; however, it remains undetermined whether the recurrent ulcer rate following PCV will be sufficiently low that the procedure can retain a position of superiority over SV-A-BI.