[Effect of proximal gastric vagotomy on the competence of the lower sphincter of the esophagus].

The aim of this prospective study was to assess the effects of highly selective vagotomy on lower esophageal sphincter pressure, and to determine whether or not it leads to increased gastroesophageal reflux. Fifteen patients (4 females, 11 males), mean age 43 years (22-63) suffering from duodenal ulcer without any clinical or pH evidence of gastroesophageal reflux were treated by highly selective vagotomy. All of them were studied before and 3-6 months after operation by history taking, pH reflux, manometric, and acid secretory pentagastrin tests. After operation none of the 15 patients had clinical evidence of duodenal ulcer or gastroesophageal reflux. The basal and stimulated acid outputs were decreased after vagotomy; pre and postoperative values were 6.8 +/- 8.9 mmol/h and 0.9 +/- 1.6 mmol/h; 42.2 +/- 10.3 mmol/h and 21.4 +/- 6.4 mmol/h, for BAO and PAO respectively (p less than 0.001). The lower esophageal sphincter pressure was 22.5 +/- 5.6 cm H20 before and 21.1 +/- 4.9 cm H20 after surgery (p less than 0.01). None of the values were lower than normal. There was no significant difference in pH reflux tests; the total duration of pH less than 5 reflux was 1.2 +/- 2.1 p. 100 before, and 1.9 +/- 2.8 p. 100 after vagotomy. These results suggest that an efficient highly selective vagotomy does not impair lower esophageal sphincter efficiency in patients-without gastroesophageal reflux, and that the routine addition of an antireflux procedure is not well advised.