A five to ten year follow-up study of parietal cell vagotomy.

Records of 51 consecutive patients who underwent parietal cell vagotomy at the Lahey Clinic Medical Center and who had follow-up studies of five to ten years were reviewed. Operation was performed for intractability in 25 patients, intractability and obstruction in 19 patients and bleeding in seven patients. Patients with pyloroduodenal stenosis underwent digital dilation. No operative deaths occurred. Ulcer recurred in two of 25 patients (8 per cent) treated for intractability, in three of 19 patients with obstruction and in two of seven patients operated upon for bleeding. Ulcers recurring in patients operated upon for obstruction developed in the first two years after operation and were frequently gastric. Recurrences in patients treated for intractability were seen throughout the ten years of follow-up study. Of the seven patients who had a recurrence of an ulceration, five were treated successfully with medical therapy and two required truncal vagotomy with antrectomy. Functional results graded according to the Visick criteria revealed excellent to good results in 27 of 32 (84 per cent) of patients without obstruction and in 11 of 19 patients (58 per cent) with obstruction before operation (p less than 0.05). Fair to poor results were attributed to recurrent ulcers in the group of patients without obstruction and to symptoms of delayed gastric emptying in the group of patients with obstruction. We consider parietal cell vagotomy the procedure of choice to use for patients with intractable duodenal ulcer, but we have abandoned use of pyloroduodenal dilation in the patient with appreciable obstruction from fibrosis.