A controlled trial of vagotomy and gastroenterostomy, vagotomy and anterectomy, and subtotal gastrectomy in the elective treatment of duodenal ulcer has been running since 1959. It included 452 patients of both sexes. Particular attention has been directed to the 375 men, of whom all survived their operation, but 18 died subsequent to discharge from hospital of intercurrent conditions and 15 were lost to follow-up. The 342 traced male cases have been reviewed annually, and this paper describes the latest results obtained on them at follow-up five to eight years after operation: (1) Most “postgastric operation syndromes” occurred with roughly equal frequency after all three operations, but early dumping was marginally more common and severe after subtotal gastrectomy; however, it very seldom assujned crippling proportions. Diarrhoea was certainly more frequent after the two vagotomy operations than after gastrectomy, but most of it was very slight and occurred episodically, so that it was only rarely a source of disability. (2) A comparison between the postoperative weight of patients and the optimal weight of individuals of the same age and height, as calculated from life assurance tables, showed a distinctly greater reduction of weight after gastrectomy and vagotomy and antrectomy than after vagotomy and gastroenterostomy. (3) Recurrent ulceration was diagnosed in 7 to 10% of patients after vagotomy and gastroenterostomy and in 2 to 5 or 6% of patients after vagotomy and antrectomy or subtotal gastrectomy. (4) Overall assessment of the quality of the results (Visick grading) after the three operations showed vagotomy and antrectomy and subtotal gastrectomy to be slightly superior to vagotomy and gastroenterostomy, but the difference was statistically insignificant. The results of all operations tended to deteriorate gradually with the passage of time. The results in female patients were analysed only in those who had had vagotomy and gastroenterostomy. A comparison of the outcome of this operation in women and men, revealed that the results were distinctly poorer in the former, with I higher incidence of most postgastric operation symptoms and of recurrent ulceration than in men. © 1968, British Medical Journal Publishing Group. All rights reserved.
