Prospective 14- to 18-year follow-up study after parietal cell vagotomy.

One hundred and thirty-five patients underwent elective parietal cell vagotomy for duodenal, pyloric or prepyloric ulcers. The patients were followed prospectively at intervals of 1-3 years in order to detect postvagotomy symptoms and recurrent ulcers; 14-18 years after surgery 106 patients were studied with regard to recurrent ulceration and 84 concerning postvagotomy symptoms. Thirty-two patients (30 per cent) had developed proven recurrent ulcers and a further 9 per cent were suspected of having recurrences. Two patients were reoperated for gastric outlet obstruction and one for bile reflux gastritis. Four patients had severe dyspeptic symptoms and four severe dyspepsia plus dumping. No patient had severe diarrhoea. Forty-three patients were regarded as failures after parietal cell vagotomy. After treatment of these failures 88 per cent of the patients available for subsequent follow-up had satisfactory results. The alternatives to parietal cell vagotomy are discussed. It is concluded that although parietal cell vagotomy has a high long-term recurrence rate, this disadvantage is outweighed by the low incidence severe postvagotomy symptoms.