CLINICAL COMPARISON OF VAGOTOMY AND PYLOROPLASTY WITH OTHER FORMS OF ELECTIVE SURGERY FOR DUODENAL ULCER

Between 1963 and 1965, 175 men with duodenal ulcer were treated by elective truncal vagotomy and Heineke-Mikulicz pyloroplasty with two operative deaths from cardiac complications and four subsequent deaths unrelated to operation. Of the 169 surviving patients 158 attended for review two years after operation. The results elicited were contrasted with those obtained in a previous study of patients two years after elective vagotomy and gastroenterostomy, vagotomy and antrectomy, and subtotal gastrectomy for duodenal ulcer: (1) Of the various postgastric operation syndromes the only ones that were less common after vagotomy and pyloroplasty than after vagotomy and gastroenterostomy were bilious vomiting, early dumping, and diarrhoea, but the differences were statistically insignificant. (2) Within two years of operation recurrent ulceration had been diagnosed in 6.3% of patients after vagotomy and pyloroplasty, as contrasted with 3.6% of patients after vagotomy and gastroenterostomy and none of the patients after vagotomy and antrectomy or subtotal gastrectomy. (3) Overall assessment (Visick grading) of the outcome after the various operations gave poorer results after vagotomy and pyloroplasty than after any other method; the difference as compared with vagotomy and antrectomy or subtotal gastrectomy was statistically significant, but as against vagotomy and gastroenterostomy it failed to achieve significance. © 1968, British Medical Journal Publishing Group. All rights reserved.