A followup report of a prospective evaluation of vagotomy-pyloroplasty and vagotomy-antrectomy for treatment of duodenal ulcer.

A prospective randomized study of 200 consecutive patients who required elective operation for treatment of duodenal ulcer was conducted. Truncal vagotomy and drainage (V-D) was done in 108 patients with a 2% mortality and truncal vagotomy and antrectomy (V-R) were performed in 92 patients with no mortality. Ninety-four per cent of these patients were followed 5-8 years after operation or until their death if that preceded the termination of the study. The immediate postoperative morbidity including stomal dysfunction and reoperation was greater after V-D than after V-R. In the opinion of the patients and independent investigators, the number of gastrointestinal complaints was similar throughout the study for the two groups of patients. In the opinion of the author, however, more gastrointestinal complaints occurred in patients from the V-R group than from the V-D group. Because of the subjectivity involved in the evaluation of these complaints, it is unknown whether a real difference existed between the two groups of patients. No patient in either group was symptomatically disabled after operation. There were nine recurrent ulcers requiring reoperation after V-D and one after V-R. The insulin test was positive in 58% of patients after V-D and 14% after V-R. These figures were essentially unchanged from those in the first report made three to five years after operation. The basal acid output and the response to histalog stimulation also remained unchanged in the two groups of patients during the same period. This study suggests that if one abstains from resection in patients where technical difficulties with the duodenum can be expected, V-R can be performed in the remaining patients with a mortality rate equally as low as that usually reported for V-D. It is concluded that V-R is superior to V-D for the majority of patients because it is associated with fewer recurrent ulcers without a significant difference in the severity of other postoperative gastrointestinal complaints.