Clinical, secretory and motor effects of selective proximal vagotomy. A three-year follow-up.

Sixty-three patients with duodenal ulcer were operated upon with selective proximal vagotomy (SPV). In 34 patients the vagotomy was combined with a pyloroplasty (PP). Before and after operation the acid secretion was investigated after Histalog (50 mg) stimulation. Insulin tests were performed 4-6 weeks, 1 year, and 3 years after operation. One and 3 years after operation ESR, Hb, SeFe, Protein, Albumin, Calcium, and Alkaline phosphatases were determined. One patient developed gastric retention and 3 got relapses during the first year. At reoperation, overlooked vagal branches in the region of the cardia were found. Five patients developed a minor anemia and 2 sideropenia, which is less than after truncal vagotomy and PP. The operation caused a highly significant reduction in acid output after Histalog stimulation. The postoperative insulin test was graded according to Bachrach: 49 were complete, 12 extensive but incomplete, and 2 incomplete. During the second hour after stimulation a probably significant increase was noted in the acid output between the postoperative and the one-year investigation. Between the one- and the three-years tests a significant increase was found during the first hour after insulin stimulation and a probably significant increase during the second hour. The gastric emptying of a composite fluid test meal was significantly faster after operation than before in patients where the insulin stimulation did not give rise to any acid production.