Late results od selective proximal vagotomy with or without pyloroplasty in uncomplicated chronic duodenal ulcer

The authors analysed the late-term results of treatment 5 and 8 years after selective proximal vagotomy (SPV) and after SPV with pyloroplasty. Each group contained 39 patients. It is shown that pyloroplasty had no significant effect on the frequency of post-vagotomy complications, though the lactase deficiency syndrome developed more frequently. The authors believe that SPV without pyloroplasty is the operation of choice in uncomplicated duodenal ulcer.     

Unextended and extended selective proximal vagotomy in the treatment of chronic uncomplicated duodenal ulcer

Comparison of the results of selective proximal vagotomy (SPV) and extended selective proximal vagotomy (eSPV) in identical groups of patients with chronic uncomplicated peptic ulcer of the duodenum showed that early postoperative complications are encountered more frequently after eSPV. The decrease in gastric secretion is similar, delayed evacuation is more marked after eSPV. The ulcerous defect healed within equal periods, the late results were the same. In view of the above stated, the authors claim that patients with moderately increased gastric secretion (acidity below 45 mEq/hour) should be preferably treated by SPV; the indications for eSPV need further study.     

10 years' results following proximal selective vagotomy in duodenal ulcer disease. A prospective study

The results 10 years after proximal gastric vagotomy for chronic duodenal ulcer disease in a prospective trial are presented. Among 76 patients 5 were lost to follow-up, 3 had died from causes unrelated of ulcer disease. 80.3% of the patients remained clinically free from recurrence. 92.2% had a Visick grade I or II. The symptomatic recurrence rate was 19.7%, total recurrence rate including asymptomatic recurrences having been 25.3%. 6 patients (8.4%) had to be reoperated, 12 (16.9%) were treated medically. 3/4 of the medically treated patients only had 1 recurrence throughout 10 years. The rate of mild dumping and diarrhea was 2% each. Patients with recurrence showed no more significant reduction of BAO or pentagastrin stimulated maximal acid output (MAO) 10 years postoperatively. Patients without recurrence had a significant reduction of BAO and MAO of 42%. Based upon the results presented, the indication for proximal gastric vagotomy for chronic duodenal ulcer is still justified.     

Problems in treating duodenal ulcer by selective proximal vagotomy

The gastric secretion after different types of vagotomy was studied in experiments on dogs and in clinic. The ordinary selective proximal vagotomy (SPV) and the truncal vagotomy were successively performed in one and the same animal and the secretion of the Pavlov and Heidenhein stomachs was investigated. The cerebral phase of secretion proved to be inhibited similarly after all the types of vagotomy. As to the ventricular phase, it was most of all decreased following SPV without a draining operation. The clinical part of the work covers 148 patients with duodenal ulcers subjected to SPV without a draining operation (51 patients) and in combination with pyloroplasty (97 patients). The investigation of gastric secretion in these patients has shown the greatest decrease of it to occur after SPV without a draining operation. The same findings show that after SPV without a draining operation the damping syndrome and diarrhea are observed rarer than after all types of vagotomy combined with pyloroplasty.     

Five to nine years' results of selective proximal vagotomy with and without pyloroplasty for duodenal ulcer.

In a retrospective study the clinical and secretory results of 118 patients operated upon with selective proximal vagotomy (SPV) with or without pyloroplasty for duodenal ulcer were examined. The results of surgery in the two groups, with pyloroplasty or without pyloroplasty, were compared. The recurrence rate was higher, although statistically not significant, for patients operated upon without pyloroplasty (19.2%) than for patients operated upon with pyloroplasty (10.6%). Dumping was significantly more common and more severe after SPV with pyloroplasty than after SPV without pyloroplasty. The acid response to histalog stimulation at follow-up was significantly higher for patients operated upon without pyloroplasty. This study indicates that SPV without pyloroplasty results in less dumping but gives a poorer protection against recurrent ulceration than does SPV with pyloroplasty. Further long-term studies appear to be necessary, however.     

Late results of selective proximal vagotomy with transverse gastroduodenal anastomosis in pyloric stenosis caused by duodenal ulcer

The late-term results of treatment of pyloroduodenal ulcerous stenosis by means of selective proximal vagotomy (SPV) in combination with transverse gastroduodenoanastomosis (GDA) were studied in 110 patients. The results are compared with those of SPV combined with longitudinal GDA after Jaboulay. Clinical, radiological, endoscopic, biochemical, and morphological examination showed the advantages of transverse GDA over longitudinal GDA. It is concluded that combination of SPV with transverse GDA is the operation of choice.     

Effect of selective proximal vagotomy on pancreatic islet function in duodenal ulcer]

The tolerance to glucose and immunoreactive insulin blood level in duodenal ulcer cases before operation and following selective proximal vagotomy combined with stomach drainage and without the latter has been studied. These operations result in the normalization of the body tolerance to glucose disturbed in duodenal ulcer. The insular function of the pancreas does not get upset therewith.     

选择性迷走神经切断术加胃窦切除术治疗十二指肠溃疡远期疗效观察

目的：研究选择性迷走神经切断加胃窦切除术（SV＋A）治疗十二指肠溃疡远期疗效。方法：1977年11月－2001年11月采用SV＋A治疗193例十二指肠溃疡患者,其中顽固性溃疡28例,溃疡伴出血112例,溃疡伴幽门梗阻41例,胃十二指肠复合性溃疡12例。结果：SV＋A术后及术后随访基础胃酸分泌（BAO）、胰岛素刺激后胃酸分泌（IMAO）、五肽胃泌素刺激后胃酸分泌（PMAO）和血清胃泌素显著下降,壁细胞呈现分泌抑制的特征;术后1－10年和11－24年的随访,患者属于Visick I、Ⅱ级分别占95．60％和96．61％,Ⅲ级分别占（4．40％）和（3．39％）,无溃疡复发。结论：SV＋A降酸显著而持久,无溃疡复发。该术式是手术治疗十二指肠溃疡特别是溃疡并发症的有效方法。     

Selective proximal vagotomy in stenosing and penetrating duodenal ulcer

In duodenal ulcer with complete pyloric stenosis selective proximal vagotomy in connection with either pyloric dilatation or duodenoplasty is generally indicated. Pyloroplasty may still be considered as an acceptable alternative drainage procedure. In high risk patients with pyloric stenosis, especially in the very old, truncular vagotomy with an adequate drainage is the operation of choice because of its low operative trauma. Penetrating ulcers are treated by selective proximal vagotomy only. Postoperative pyloric stenosis occurs rarely and should be managed by secondary pyloroplasty or pyloric dilatation.     

Selective proximal vagotomy with excision of duodenal ulcer

257 patients with duodenal ulcer and its complications underwent selective proximal vagotomy in combination with excision of duodenal ulcer without pyloric injury. Lethality rate was 0.78%. Long-term results of the operation by Visick's classification are evaluated as excellent and good in 105 (90.5%) patients, in 9 (7.8%) as satisfactory, in 2 (1.7%) as unsatisfactory. It is emphasized that operation saving the pylorus is optimal in such patients and can be performed almost in all patients irrespective of location of the ulcer, presence and tupe of its complications.     

Reaction of HCl secretion, total proteolytic activity and pepsin after a selective proximal vagotomy in duodenal ulcer patients]

The gastric secretion of hydrochloric acid, total proteolytic activity, and especially pepsin were studied before and 6 months after selective proximal vagotomy in 15 patients suffering from recurrent duodenal ulcer, and compared with that of ten sound volunteers. The patients with duodenal ulcer showed a significantly increased secretion of acid and proteolytic enzymes. After vagotomy, the basal acid output was reduced by 70%, the secretion of the total proteolytic activity by 54%, and that of pepsin by 45%. The concentration of the total proteolytic activity and of pepsin in the gastric juice was increased after vagotomy. Although the total basal proteolytic activity after vagotomy was still increased by 15% as compared with that in the volunteers, due to the drastically reduced basal acid output the actual intragastric basal proteolytic activity was expected to be reduced after vagotomy.