Highly selective vagotomy--a safe operation for duodenal ulcer. Immediate and long-term complications and sequelae in 500 patients.

The safety and efficacy of highly selective vagotomy were assessed in a prospective series of 500 patients who underwent the operation during a 15-year period. There was no peroperative or immediate postoperative mortality. None of the 22 late deaths was attributable to the operation. In six cases complications prolonged the hospital stay beyond 21 days, requiring a second laparotomy in four. The rate of ulcer recurrence was 18.5% by 15 years. Bloating was the commonest long-term complication (8.8%), but half of these patients regarded the operation as successful. Less common were dumping (5.4%), diarrhoea (3.8%) and gastric stasis (1.4%). Revisional surgery was performed on 37 patients--for recurrent ulcer in 28, for gastric stasis in seven and for perforation in two. Although almost 20% of the reviewed patients continue to require regular or frequent medication, the study shows that highly selective vagotomy can be therapeutically effective for duodenal ulcer, particularly in preventing haemorrhage and perforation in patients who have previously suffered these complications. Above all it is a safe operation with low long-term morbidity.