Recurrent ulceration after proximal gastric vagotomy for duodenal ulcer.

Abstract

AbstractProximal gastric vagotomy has been performed in 605 patients. Ulcer recurrence occurred in 59 (9.8%) and the relationship of recurrent ulceration to age, sex, gastric emptying time, and gastric acid secretion has been examined. The recurrence rate in 428 of the patients followed for more than 5 years was 11.4%. There was no significant difference in recurrence rates between men and women. Less than half of the recurrences were located in the duodenal bulb (40%). No significant difference in gastric emptying time was found between patients with and without recurrence. The results of the 3 gastric secretion tests—basal acid output (BAO), maximal acid output (MAO), and the insulin test—showed that patients with ulcer recurrence in the duodenal bulb, both pre‐ and postoperatively, had significantly higher mean values of acid secretion than the other patients with recurrence and the control group without recurrence. At the time of recurrence, the mean values of acid secretion in patients with duodenal recurrence were significantly higher than in the control group, and the insulin test was Hollander positive in 87% of the patients. The acid secretion in patients with pyloric, prepyloric, and gastric recurrence was not significantly different from the control group. The results suggest that an incomplete vagotomy is an important factor in the development of ulcer recurrence in the duodenal bulb. Recurrences confined to the stomach, however, seem to develop in spite of an adequate vagotomy and no causal factor could be discovered in these patients.