Physiological and clinical significance of highly selective vagotomy without a drainage procedure.

Abstract

This is an account of the first 5 ½-years’ experience of highly selective vagotomy (HSV), an operation which confines vagotomy to the parietal cell mass, leaving the gastric antrum innervated and the pyloric sphincter intact. Gastrin levels have been shown to be no higher after HSV than after truncal vagotomy (TV). The long-term reductions in acid output after HSV are approximately equal to the reductions which are found after TV or SV (selective vagotomy), but the response to insulin is greater after HSV than after TV or SV. Gastric emptying of fluids is under better control after HSV than after TV/SV with a drainage procedure (D). The gall bladder is dilated after TV, but not after SV or HSV. Pancreatic enzyme output in response to vagal stimulation is significantly greater after HSV than after TV + D. Faecal fat excretion is significantly less after HSV than after TV/SV+ D. Operative mortality after 400 HSVs was nil. Post-operative gastric stasis was very rare. Dumping and diarrhoea were significantly less common after HSV than after TV/SV + D: other side effects were no more common. Despite the presence of the innervated antrum, the incidence of recurrent ulceration after HSV was low. 88% of patients had excellent clinical results 2–4 years after HSV, compared with only 70% after vagotomy with drainage.