Before being superseded by medical management, highly selective vagotomy (HSV) without drainage was the procedure of choice for uncomplicated duodenal ulcer. It is also justified for complications, including perforation and bleeding in selected cases. This prospective study evaluated the effects of HSV plus drainage on solid gastric emptying in 20 patients with chronic duodenal ulcer and pyloric stenosis. Patients were treated with HSV plus pyloroplasty (Heineke-Mikulicz pyloroplasty in five patients, Finney pyloroplasty in six patients and Jaboulay gastroduodenostomy in nine patients) and underwent solid-phase gastric emptying scintigraphic studies pre-operatively and 2 months and 6 months post-operatively. Results were compared with those from 10 controls. No significant differences were observed between the different types of pyloroplasty, although emptying was slightly faster in the gastroduodenostomy group. Gastric emptying returned to normal by 6 months post-operatively. In conclusion, HSV plus pyloroplasty is effective and can be used for the relief of stenosis in selected cases of duodenal ulcer.
OzmenMMPatankarRJohnsonCD: Helicobacter pylori: an update for surgeons. In: Recent Advances in Surgery, Vol. 21 (JohnsonCD, ed). London: Churchill Livingstone1996; pp 61–76.
2.
HuntPS: Bleeding gastroduodenal ulcers: Selection of patients for surgery. World J Surg1987; 11: 289–294.
3.
KonessRJCutitarMBurchardKW: Perforated peptic ulcer. Determinants of morbidity and mortality. Am Surg1990; 56: 280–284.
4.
DonahuePEYoshidaJRichterHMLiuKBombeckCTNyhusLM: Proximal gastric vagotomy with drainage for obstructing duodenal ulcer. Surgery1988; 104: 757–764.
5.
JohnstonD: Operative mortality and postoperative morbidity of highly selective vagotomy. Br Med J1975; 4: 545–547.
6.
JepsonKLariJHumphreyCSSmithRBWilkinsonARJohnstonD: A comparison of the effect of truncal, selective and highly selective vagotomy on maximal acid output in response to pentagastrin. Ann Surg1973; 178: 769–772.
7.
LyndonPJGreenallMJSmithRBGoligherJCJohnstonD: Serial insulin tests over a five year period after highly selective vagotomy for duodenal ulcer. Gastroenterology1975; 69: 1188–1195.
8.
AdamiHOEnanderLKEnskogLIngvarCRydbergB: Recurrences 1 to 10 years after highly selective vagotomy in prepyloric and duodenal ulcer disease. Frequency, pattern, and predictors. Ann Surg1984; 199: 393–399.
9.
McMahonMJGreenallMJJohnstonDGolligherJC: Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration. Gut1976; 17: 471–476.
10.
LundeOLiavagIRolandM: Proximal gastric vagotomy and pyloroplasty for duodenal ulcer with pyloric stenosis: A thirteen-year experience. World J Surg1985; 9: 165–170.
11.
GoldsteinHBoyleJD: The saline load test - a bedside evaluation of gastric retention. Gastroenterology1965; 49: 375–380.
12.
WangCSTzenKYHuangMJChenPCChenMF: Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer. World J Surg1991; 15: 286–292.
13.
HomSSarrMGKellyKAHenchV: Postoperative gastric atony after vagotomy for obstructing peptic ulcer. Am J Surg1989; 157: 282–286.
14.
ChangTMChenTHTsouSSLiuYCShenKL: Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy. J Gastrointest Surg1999; 3: 533–536.
15.
StavrakaAMadanAKFrantzidesCTApostolopoulosDVlontzouE: Gastric emptying time, not enterogastric reflux, is related to symptoms after upper gastrointestinal/biliary surgery. Am J Surg2002; 184: 596–600.
16.
ShaoulREnavBSteinerZMogilnerJJaffeM: Clinical presentation of pyloric stenosis: The change is in our hands. Isr Med Assoc J2004; 6: 134–137.
17.
ArasakiCHMartinezJCdel GrandeJC: Oximetry of stomach: Comparative study between proximal gastric vagotomy and anterior lesser curve seromytomy with posterior truncal vagotomy in chronic duodenal ulcer (in Portuguese, English abstract). Rev Assoc Med Bras2002; 48: 323–328.
18.
MistiaenWVan HeeRBlockxP: Gastric emptying of liquid meals after anterior gastric stapling and posterior truncal vagotomy in beagle dogs: Discrepancy with results for solid food. Hepatogastroenterology1998; 45: 286–292.
19.
MarianiGBoniGBarrecaMBelliniMFattoriBAlSharifA: Radionuclide gastroesophageal motor studies. J Nucl Med2004; 45: 1004–1028.
20.
WilburBGKellyKA: Effect of proximal gastric, complete gastric and truncal vagotomy on canine gastric electric activity, motility, and emptying. Ann Surg1973; 178: 295–303.
21.
FaxenAAlpstenMCederbladAKewenterJRossanderL: The effect of parietal cell vagotomy and selective vagotomy with pyloroplasty on gastric emptying of a solid meal. A prospective randomized study. Scand J Gastroenterol1978; 13: 727–733.
22.
LundeOCLiavagIRolandM: Recurrent ulceration after proximal gastric vagotomy for duodenal ulcer. World J Surg1983; 7: 751–756.
23.
EmasSGrupcevGErikssonB: Six-year results of a prospective randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcer. Ann Surg1993; 217: 6–14.
24.
ChangTMChenTHShihCMGuengMKTsouSS: Partial or complete circular duodenectomy with highly selective vagotomy for severe obstructing duodenal ulcer disease: An initial experience. Arch Surg1998; 133: 998–1001.
