The Aarhus County Vagotomy Trial: trends in the problem of recurrent ulcer after parietal cell vagotomy and selective gastric vagotomy with drainage.

Abstract

AbstractIn a prospective, randomized study, 691 patients with duodenal (DU), pyloric (PU), or prepyloric (PPU) ulcers have been followed for 2–5 years after operation with parietal cell vagotomy (PCV) or selective gastric vagotomy with drainage (SGV+D). About half the patients have been followed for 5 years. Cumulative 5‐year recurrence rates, calculated by a life table method, suggest a higher recurrence rate for patients with DU when operated with PCV (15%) than when operated with SGV + D (9%), but the difference was not statistically significant (p>0.05). Patients with PU/PPU had higher recurrence rates following either procedure than patients with DU (PCV: 33%; SGV+D: 14%).A study of the change in recurrence risk as a function of time after operation suggests that the recurrence rate following SGV+D when used for DU will continue to rise after 5 years, but probably very slowly. The recurrence rate after 5 years is unpredictable, however, for PCV when used for DU, and unpredictable for both methods when used for PU/PPU.The recurrence rate was found to be independent of the level of preoperative gastric acid secretion, and this was true for both PCV and SGV+D, An increased recurrence rate was, on the other hand, found to be associated with <50% postoperative reduction in pentagastrin‐stimulated acid secretion.