Effect of proximal gastric vagotomy on feeding stimulated Heidenhain pouch acid secretion and gastrin release.

Truncal vagotomy (TV) is known to increase the feeding stimulated acid output of Heidenhain pouches. A series of experiments were performed in dogs to see if proximal gastric vagotomy (PGV) also had this effect. Dogs were prepared with gastric fistulas (GF) and Heidenhain pouches (HP). Gastric function testing included three categories of tests: (1) serum gastrin determinations and Heidenhain pouch acid secretion after feeding, (2) gastric emptying and simultaneous Heidenhain pouch acid secretion, and (3) gastric and Heidenhain pouch acid secretion and serum gastrin levels after insulin. Compelte testing consisting of two control and two post-PGV tests was accomplished in five dogs in each category. Insulin testing confirmed that an adequate PGV was performed because GF peak acid output in response to 0.5 U/kg insulin IV was reduced 88% by PGV (p less than .01). In response to two separate meals peak acid output (PAO) from the HP's was not increased significantly after PGV: Meal I pre-PGV 450 +/- 112 vs post-PGV 400 +/- 99 muEq/15 min; Meal II pre-PGV 256 +/- 62 vs post-PGV 304 +/- 150 muEq/15 min. This finding may represent an important physiologic difference between PGV and truncal vagotomy.     

Proximal gastric vagotomy and mucosal antrectomy: effect on gastric acid secretion, plasma gastrin, and experimental ulcerogenesis in the dog

The aim of this study was to determine whether mucosal antrectomy, which preserves antropyloric motility, would enhance the antiulcer properties of proximal gastric vagotomy (PGV). Hydrochloric acid and gastrin secretion were studied in five dogs before and after PGV and mucosal antrectomy, while the response to the Mann-Williamson operation (an ulcer-producing operation) was evaluated in four control dogs with intact stomachs, five dogs with PGV alone, and six dogs with PGV plus mucosal antrectomy. Proximal gastric vagotomy and mucosal antrectomy decreased mean +/- SEM basal and pentagastrin-stimulated acid secretion from 4.3 +/- 1.3 to 0.4 +/- 0.3 mEq/hr and from 21 +/- 0.7 to 7.4 +/- 1.8 mEq/hr, respectively (p less than 0.05). Basal plasma gastrin was altered little by the operation (68 +/- 9.7 pg/ml before, 58 +/- 11 pg/ml after; p greater than 0.05) but the 4-hour integrated plasma gastrin response to a 200 gm meat meal decreased from 13 +/- 1.8 to 3.3 +/- 0.7 ng X min/ml (p less than 0.05). Only one of six dogs with mucosal antrectomy and PGV developed peptic ulcer after the Mann-Williamson operation, whereas four of five with PGV alone and three of four controls developed ulcers (p less than 0.05, PGV alone versus PGV and mucosal antrectomy). In conclusion, PGV and mucosal antrectomy decreased acid secretion and postcibal gastrin response and provided greater protection against peptic ulcer than PGV alone.     

Effect of proximal gastric vagotomy on the activity of hydrogen, potassium-stimulated ATPase in the gastric mucosa of patients with duodenal ulcer.

OBJECTIVE--To find out if there was a correlation between hydrogen, potassium stimulated ATPase (H,K-ATPase) activity and gastric acid secretion in patients with duodenal ulcers after proximal gastric vagotomy. DESIGN--Retrospective study. SETTING--Regional referral center. SUBJECTS--61 patients with chronic duodenal ulcers divided into three groups: patients who had not been operated on but had exacerbations of their symptoms (n = 39): those who had been treated successfully by proximal gastric vagotomy either less than 1 year ago (n = 7) or greater than or equal to 1 year ago (n = 9): and those patients who presented with recurrent ulceration after proximal gastric vagotomy (n = 6). MAIN OUTCOME MEASURES--Measurement of H,K-ATPase activity and gastric acid secretion. RESULTS--There was a decrease in H,K-ATPase activity after effective vagotomy, and enzyme activity was the lowest in patients who had been operated on 1 year ago. Both H,K-ATPase and gastric acid secretion were decreased by proximal gastric vagotomy. CONCLUSION--There may be a gradual recovery of gastric H,K-ATPase activity with time after proximal gastric vagotomy.     

Experimental study of truncal vagotomy for healing of highly located gastric ulcer

In order to investigate whether truncal vagotomy effects on the wound-healing of highly located gastric ulcer or not, the ratio of epithelialization of ulcer, gastric acidity, mucosal blood flow, mucosal PGE2 and labelling index of mucosa after vagotomy were studied by using the mongrel dogs which were prepared highly located penetrated gastric ulcer. Following results were obtained. 1. The ratio of epithelialization of vagotomized dogs at the third week after preparing ulcer showed significant high ratio compared with non-vagotomized dogs. Comparing thoracic truncal vagotomy with abdominal truncal vagotomy, the former was more effective than the latter. 2. Mucosal blood flow and gastric acidity were reduced after vagotomy. 3. Mucosal PGE2 decreased at the first week after vagotomy, however, reduced PGE2 recovered up-to the level with non-vagotomized dogs at the second week after thoracic truncal vagotomy and at the third week after abdominal truncal vagotomy, respectively. 4. Labelling indexes showed significant high counts after vagotomy compared with non-vagotomy. In conclusion, it was suggested that truncal vagotomy would be effective on the wound-healing of ulcer due to the reduction of acid out-put and only a transient decrease of PGE2, however, mucosal blood flow decreased after vagotomy.     

Proximal gastric vagotomy and mucosal antrectomy: a comparative physiologic examination

Proximal gastric vagotomy-mucosal antrectomy (PGV-MA) was devised in an attempt to reduce the cephalic and hormonal phases of acid secretion without disturbing gastric emptying. The current study determines the effects of proximal gastric vagotomy (PGV), or PGV-MA on acid secretion, gastrin, and gastric emptying. Twelve dogs underwent measurement of gastric emptying, fasting and postcibal acid production, and fasting and postprandial gastrin levels. The animals then underwent either PGV or PGV-MA and the studies were repeated. PGV markedly decreased basal acid (P less than 0.001); however, there was still a large postprandial acid increase. In contrast, PGV-MA nearly abolished both fasting and postprandial acid secretion (difference from control and PGV significant at P less than 0.001). Gastric emptying was not significantly altered by either procedure. PGV was associated with increased fasting and postprandial gastrin levels, while PGV-MA produced lower gastrin levels at all intervals than either controls or PGV-MA. PGV-MA emulates the effects of truncal vagotomy and antrectomy on acid secretion, without affecting gastric emptying and deserves further investigation as a possible surgical alternative in the treatment of duodenal ulcer disease.     

Truncal vagotomy as a possible potentiator of gastric atony

To stimulate ulcer patients undergoing operation for gastric outlet stenosis, pyloric obstruction was created in dogs and repaired with pyloroplasty to which was added truncal vagotomy, proximal gastric vagotomy, or no vagotomy. Gastric antral contractile activity after feeding a solid meal was studied before and after repair (2 week period of study). This activity was correlated with the initial lag and regulated phases of solid meal emptying. Five quantified indices of contractile activity measured during the first postprandial hour indicated variable and inconclusive results in the antrum during the lag phase (first 20 minutes). Consistent percentage changes in these indices after obstruction repair were seen during the subsequent regulated phase. Gastric work was reduced 28 to 35 percent, but not work capability (mean area), by pyloric obstruction in the no vagotomy dogs. Reductions seen in proximal gastric vagotomy dogs were not different from those in the no vagotomy dogs. Higher percentages of reduction in amplitude (70 percent) and mean area of contractions (53 percent) occurred after truncal vagotomy compared with what occurred in the no vagotomy dogs. Mean area was also reduced more compared with what occurred in the proximal gastric vagotomy dogs. These data indicate that the reduced gastric work after feeding and impaired work capability caused by truncal vagotomy when superimposed on that produced by pyloric obstruction may exaggerate gastric atony and contribute to the delayed recovery of gastric emptying seen in the clinical setting.     

Effect of duodenal switch procedure on gastric acid production, intragastric pH, gastric emptying, and gastrointestinal hormones.

The duodenal switch operation preserves the pylorus and the proximal 3 to 7 cm of duodenum in continuity with the stomach while diverting pancreaticobiliary secretions. We compared it with the Roux-en-Y without vagotomy or antrectomy in 12 dogs with innervated gastric pouches. Acid secretion was inhibited between tests using ranitidine in the Roux-en-Y group only, but two of the six dogs still developed stomal ulcers and the remainder showed stomal hyperemia. This may be due to a significant increase in gastric acid output after Roux-en-Y, but gastric emptying and plasma gastrin, cholecystokinin, secretin, gastric inhibitory polypeptide, peptide YY, and neurotensin were similar after both procedures. In 12 patients and a further 6 dogs, the duodenal switch caused no significant change in the intragastric pH environment as assessed by intragastric pH monitoring. The duodenal switch is a suitable procedure for pancreaticobiliary diversion.     

Proximal gastric vagotomy and suprapyloric antrectomy. Experimental evaluation in dogs.

In five dogs with Heidenhain pouches, proximal gastric vagotomy and suprapyloric antrectomy did not alter the rate of gastric emptying of 300 mL of 1% dextrose or of 40 plastic spheres, or disrupt the barricade preventing duodenogastric reflux. However, the operation did slow gastric emptying of 50 g of cubed liver and increase the postprandial secretion of hydrochloric acid from the pouch. We concluded that suprapyloric antrectomy can be combined with proximal gastric vagotomy without disturbing the gastric emptying of liquids and indigestible solids or resulting in increased duodenogastric reflux. However, the operation does slow gastric emptying of digestible solids.     

Histochemical and electron microscopic observation of the gastric wall after vagotomy

Eight dogs underwent gastric total truncal vagotomy and another 8 had gastric superselective vagotomy. Specimens were take from anterior wall of gastric corpus and antrum at weeks after operation for histochemical and electron microscopic observation. The results showed: (1) the sympathetic postganglionic fibers in gastric wall were completely damaged. (2) response of gastric antrum mucosa to CCK-8 and gastric G-17 lowered markedly. (3) the amount of parietal cells increased, the structure of follicular atrophied, the number of mitochondrion in cytoplasm, and the stroma and micrailli on folilculi wall increased. (4) The Campylobacter-like organism (CLO) were found in mucosa of gastric antrum and corpus after operation. The authors discussed the role of gastric sympathetic nerve on gastric secretion and movement, and the relationship between CLO and ulcer recurrence after gastric superselective vagotomy.     

Influence of the abdominal vagi and gastric antrum on humoral control of gastric acid secretion

The influence of the abdominal vagi (especially the gastric antral branch), the antrum, and the duodenum on humoral control of gastric acid secretion was studied in 9 dogs with Heidenhain pouches (HP). The dogs were divided into 2 groups and subjected to the following sequential operations:Group I: (6 dogs) The first operation was section of the antral branch of the vagus nerve. The second operation was antrectomy with Billroth I gastroduodenostomy. The third operation was transthoracic truncal vagotomy.Group II: (3 dogs) The first operation was antrectomy and Billroth II gastrojejunostomy and the second operation was transthoracic truncal vagotomy. During the control period when the dogs had only an HP, pouch acid secretion and serum gastrin level increased after feeding. After antral vagotomy, both pouch secretion and the serum gastrin level after feeding were significantly lower. The second operation of antrectomy with Billroth I gastroduodenostomy in Group I resulted in a further significant decrease in both pouch acid secretion and serum gastrin level. Similar decreases occurred after the first operation of antrectomy with Billroth II gastrojejunostomy in Group II. In both groups, after the final operation of transthoracic truncal vagotomy, pouch acid secretion tended to increase, while the serum gastrin level increased slightly in Group I but not in Group II. It is concluded that vagal innervation of the antrum plays a role in gastrin release and gastric acid secretion.

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Résumé Nous avons étudié, chez 9 chiens porteurs d'une poche de Heidenhain (PH), l'influence des branches abdominales des nerfs vagues (plus spécialement le rameau antral), de l'antre et du duodénum sur le contrôle hormonal de la sécrétion gastrique acide. Deux groupes de chiens ont été soumis aux opérations suivantes:Dans le groupe I (6 chiens), la première opération est une section du rameau antral du vague, la deuxième une antrectomie avec gastroduodénostomie de type Billroth I, la troisième une vagotomie par voie thoracique.Dans le groupe II (3 chiens), la première opération est une antrectomie avec gastrojéjunostomie de type Billroth II et la seconde une vagotomie par voie thoracique.Pendant la période de contrôle, la sécrétion acide de la PH et le taux de gastrine sérique augmentent après un repas. Après vagotomie antrale, la sécrétion de la PH et les valeurs de gastrine sérique sont réduites de façon significative. Dans le groupe I, l'antrectomie avec gastroduodénostomie diminue encore la sécrétion d'acide de la PH et la gastrinémie. Dans le groupe II, F antrectomie avec gastrojéjunostomie donne des réductions de même importance. Dans les deux groupes, la sécrétion acide de la PH tend à s'élever après vagotomie par voie thoracique. La gastrinémie augmente légèrement dans le groupe I, mais pas dans le groupe II. En conclusion, l'innervation vagale de l'antre influence la libération de gastrine et la sécrétion gastrique acide.

     

Effect of bethanechol on gastric acid secretion and serum gastrin concentration after proximal gastric vagotomy.

It has been suggested that maximal acid output decreases after vagotomy as a result of reduced cholinergic activity and that maximal acid secretion can be restored to prevagotomy levels with cholinergic agonists. To test this, a maximally tolerated dose of bethanechol (50 micrograms/kg/hr) or saline was infused intravenously in nine duodenal ulcer patients who had been treated by proximal gastric vagotomy. Bethanechol infusion significantly (p less than 0.05) increased basal acid secretion without affecting basal serum gastrin concentrations. Despite stimulation of basal acid secretion, bethanechol had no significant effect on maximal acid output in response to subcutaneous pentagastrin. Although bethanechol significantly increased maximal acid output in response to subcutaneous histamine, maximal acid secretion in response to histamine (or to pentagastrin) was not restored to the prevagotomy level in any patient. Thus, factors other than loss of cholinergic activity appear to be responsible for the large reduction in maximal secretory capacity after vagotomy.     

Decreased parietal cell acid secretion after vagotomy is not associated with altered gastric prostaglandin levels

In a previous investigation we demonstrated that after vagotomy there is a decreased ability of parietal cells to use intracellular cyclic adenosine monophosphate (cAMP). Prostaglandins are present in gastric mucosa and have been demonstrated to be inhibitors of in vivo and in vitro acid secretion through a cAMP-mediated mechanism. In the present study we have examined in vitro acid secretion and prostaglandin E2 levels in rabbits 8 weeks after vagotomy and pyloroplasty compared with control animals to investigate the possible role of prostaglandins in postvagotomy-impaired cAMP use. In vitro acid secretion was assessed in isolated gastric glands by 14C-labeled aminopyrine uptake and prostaglandin E2-generating capacity measured by high-pressure liquid chromatography. After vagotomy, there was a decrease in basal aminopyrine uptake (p less than 0.05), as well as that simulated by histamine and 8-bromo-cAMP (p less than 0.007). No differences were observed in prostaglandin E2 levels in either gastric glands or intact fundic mucosa (p greater than 0.5). These data suggest that impaired cAMP use observed in parietal cells after vagotomy is not the result of alterations in gastric prostaglandin levels.     

Anterior lesser curvature laser seromyotomy with posterior truncal vagotomy: a potential treatment of peptic ulcer disease

Anterior lesser curvature seromyotomy combined with posterior truncal vagotomy has been suggested as an alternative to proximal gastric vagotomy in the treatment of peptic ulcer. The argon laser may be an ideal instrument for performing seromyotomy. This study compares anterior lesser curvature argon laser seromyotomy/posterior or truncal vagotomy with anterior proximal gastric vagotomy/posterior truncal vagotomy in a canine preparation. Six dogs underwent anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy and six others underwent anterior proximal gastric vagotomy/posterior truncal vagotomy. Gastric emptying and acid secretion studies were performed preoperatively and at 1 and 6 months postoperatively. Operating time and blood loss were determined. Anterior lesser curvature argon laser seromyotomy was performed with the argon laser at 10 W, continuous, delivered through a 600 micron unsheathed quartz fibre. Anterior proximal gastric vagotomy and posterior truncal vagotomy were performed in the standard fashion. Solid phase gastric emptying was slowed with both operations (P less than 0.05) but this was not manifest clinically. Blood loss (millilitres) was less following anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy than following anterior proximal gastric vagotomy/posterior truncal vagotomy (21(6.8) versus 95(28.1), mean (s.e.m.), P less than 0.05) but operating time was not significantly different between the groups. Mean basal acid secretion was reduced by 64 per cent 6 months after anterior lesser, curvature argon laser seromyotomy/posterior truncal vagotomy (P less than 0.05) and by 53 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). Mean stimulated acid secretion was reduced by 41 per cent 6 months after anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy (P less than 0.05) and by 24 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). We conclude that anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy is an acceptable alternative to anterior proximal gastric vagotomy/posterior truncal vagotomy and may provide superior parietal cell denervation with less operative blood loss.     

Effect of truncal vagotomy and pyloroplasty on rat gastric mucosal H,K-ATPase and HCO3-ATPase activities.

The effect of truncal vagotomy and pyloroplasty on rat gastric mucosal H,K-ATPase and HCO3-ATPase activities was studied 15 and 30 days past the operation. A significant decrease in gastric body mucosal H,K-ATPase activity occurred 15 days after vagotomy, compared with pyloroplasty (p < 0.05) and non-operated control rats (p < 0.01). A recovery in the enzyme activity on the 30th postoperative day occurred. Gastric body and antral mucosal HCO3-ATPase activity was significantly (p < 0.01) decreased 15 and 30 days after vagotomy and pyloroplasty, compared with pyloroplasty controls. The observed changes in gastric mucosal H,K-ATPase and HCO3-ATPase activities after vagotomy reflect the decrease in gastric acid secretion, as well as the possible changes in mucosal bicarbonate secretion and acid-base status. A gradual recovery in mucosal H,K-ATPase activity after vagotomy may occur.     

Proximal gastric vagotomy with carbon dioxide laser: experimental studies in animals

Proximal gastric vagotomy has been widely used as a surgical treatment for peptic ulcer disease. However, it is technically complex and time-consuming. Moreover, it may cause circulatory problems in the gastric mucosa. We have reported a new method of blood flow-preserving vagotomy with a carbon dioxide laser (CO2 laser vagotomy) developed in our laboratory. To assess its efficacy, we used cysteamine-induced ulcer and measured gastric mucosal blood flow in rats. The incidence of cysteamine-induced ulcer formation was reduced significantly in the group that underwent CO2 laser vagotomy compared with a group treated with proximal gastric vagotomy. Gastric mucosal blood flow was significantly better in the CO2 laser vagotomy group. Long-term follow-up of acid reduction was evaluated in dogs by the pentagastrin-stimulation test. Acid reduction in dogs was satisfactory during the 12 months of this study. CO2 laser vagotomy is a new, easy, time-saving, and circulatory-preserving technique for peptic ulcer disease.     

Exocrine function of the pancreas after vagotomy with economical gastric resection]

The authors have studied the effect of vagotomy, associated with an economic gastric resection, on exocrinous function of the pancreas and compared the sequelae of selective and trunkal vagotomy in this respect. The secretin and vagus mechanisms of secretion are analysed. Ten investigations were carried out in patients with duodenal ulcerous disease prior to surgery, and in 68 patients within the terms up to 3 years postoperatively. Vagotomy results in a reliable decrease of the basal amount of pancreatic secretion in maintaining the response to stimulation with hydrochloric acid and insulin hypoglycemia. Changes in exocrinous function of the pancreas were found to be identical after trunkal and selective vagotomy.     

Gastric, pancreatic, and biliary secretion and the rate of gastric emptying after parietal cell vagotomy.

We compared the gastric, pancreatic, and biliary secretory responses to a liquid test meal and the rates of gastric emptying of liquid and solid test meals in six patients at least 1 year after parietal cell vagotomy with eight unoperated subjects, one with duodenal ulcer disease and seven normal control subjects. Parietal cell vagotomy decreased gastric acid secretion to one third of normal, but total trypsin and bile salt secretion during the first 150 postcibal minutes were normal. The liquid test meal emptied from the stomach faster after parietal cell vagotomy, the pattern of emptying being exponential in the vagotomy patients and linear in the normal subjects. The rate of gastric emptying of a liquid meal, although faster than normal, was less precipitous after parietal cell vagotomy than after truncal vagotomy plus drainage or subtotal gastrectomy, and trypsin and bile salt concentrations were not diluted to abnormal levels, as occurs after these other procedures. Furthermore, emptying and dispersion of solid food remained normal after parietal cell vagotomy. These findings probably explain, at least in part, the decreased incidence of postprandial dumping and diarrhea that accompanies parietal cell vagotomy compared with the other popular operations for duodenal ulcer.     

Regional gastric mucosal blood flow after parietal cell vagotomy in dogs

In this study we used the recently validated H2 clearance method to perform endoscopic measurements of gastric mucosal blood flow (MBF) in anesthetized dogs before and after parietal cell vagotomy (PCV). Under resting conditions, MBF in the gastric corpus before PCV was 72 +/- 5 ml/min/100 gm. This was not altered significantly at 4, 8, or 16 weeks after PCV, and there were not significant long-term changes in MBF on the greater or lesser curvatures of the corpus individually. Before PCV infusion of pentagastrin (8 micrograms/kg/hr) elicited increases in corpus MBF to 104 +/- 4 ml/min/100 gm, accompanied by increases in gastric acid output from resting levels of 2.1 +/- 0.9 to 38.6 +/- 2.4 mEq/hr (p less than 0.001). PCV significantly reduced pentagastrin-stimulated acid secretion by 50%, and secretory inhibition was accompanied by significant reductions in pentagastrin-stimulated MBF in the corpus. Pentagastrin did not alter antral MBFs before or after PCV. In summary PCV does not elicit significant long-term changes in resting MBF in different regions of the gastric corpus, and PCV significantly diminishes increases in acid output and corpus MBF that are normally stimulated by pentagastrin. These observations suggest that alterations in gastric MBF after PCV may be attributable to alterations in acid secretion.     

Experimental studies on the effect of pyloroplasty on gastric emptying, serum gastrin and duodenogastric reflux in selective proximal vagotomy (SPV)

The influence of selective proximal vagotomy (SPV) and of an additional pyloroplasty (Heineke-Mikulicz) on gastric emptying, acid and gastrin secretion, and duodenogastric reflux was examined experimentally. After SPV, gastric emptying of fluids and a solid meal was significantly faster than before surgery. An additional pyloroplasty did not influence gastric emptying time significantly. Gastrin secretion after stimulation with a protein-rich meal increased significantly after SPV and did not change much after pyloroplasty was added. It can be concluded that increased gastrin secretion after SPV is not a result of delayed emptying. Pentagastrin-stimulated acid secretion was reduced by 70% after SPV and after additional pyloroplasty as well. The results show that reduced acid secretion after SPV causes the rise in serum gastrin levels. After SPV no duodenogastric reflux occurred. An additional pyloroplasty led to a significant rise of bromsulphaleine used as a marker for bile in gastric aspirate. Obviously destruction of the pylorus leads to a loss of its antireflux function. This leads to an antral gastritis which after 3 months is of chronic-atrophic type. A stimulation of gastrin output by bile could not be demonstrated. It can be concluded that after SPV gastric emptying is not delayed. A pyloroplasty does not affect gastrin release and acid secretion. Drainage procedures together with SPV should be avoided to prevent duodenogastric reflux and antral gastritis.     

Experimental study on canine gastric motility following selective proximal vagotomy (author's transl)]

Electromyographical studies were made on the gastric motility of dogs following selective vagotomy (SV) and selective proximal vagotomy (SPV) as the subsequent studies on the changes after truncal vagotomy (TV) after which gastric motility is fairly disturbed, and the influence of pyloroplasty additionally performed to SPV. Gastric discharge frequency was suppressed by SV similar to that by TV. Dysrhythmia of motility occurred after gastric vogotomy. Restoration to the normal was the fastest after SPV. Changes in the discharge frequency after SPV did not differ much from those in the normal stomach and other types of vagotomy. With SPV, the decrease in the propagation velocity of basic electrical rhythms (BER) was mild, and a pattern similar to the control was shown compared with TV and SV. The antiperistaltic discharge was observed even with SPV, but the frequency was low compared with TV and SV. The frequency of peristaltic discharge was the highest when pyloroplasty was performed in addition to SPV. The responses to vagostigmine, insulin tetragastrin in SPV were similar to those in the normal stomach. During the gastric emptying time, there was neither difference before and after SPV, nor any significant difference due to the presence or absence of pyloroplasty. The above data show that SPV is advantageous for retaining the function of gastric peristalsis, also for gastric secretion, but the addition of pyloroplasty will not be advantageous for the elimination of gastric content.