Long-term results of vagotomy and pyloroplasty in the treatment of gastric ulcer disease.

Two hundred thirteen patients were evaluated to establish the efficacy of vagotomy and pyloroplasty in the treatment of benign gastric ulcer disease. These patients underwent operation between the years 1960 to 1973. Ten patients (5%) were found to have occult gastric malignancies and four of these patients (40%) were cured after resectional therapy. Nineteen patients underwent pyloroplasty without vagotomy, and these patients were ultimately excluded from the study in view of the frequency (26%) of ulcer recurrence. The operative mortality rate was 8.4% overall (1.5% when related to elective operations and 22% of the operative deaths following emergent procedures). Eighty-eight percent of the patients were followed until death or for a minimum of 10 years. Recurrent ulcer disease was confirmed in 11% of the patients. Severe postoperative sequelae were encountered in 3% of the patients for a total failure rate of 14% at 10 years. Recurrences and postoperative sequelae were both more common in women and in those patients who underwent operation for intractability. Vagotomy with pyloroplasty is considered an acceptable alternative operation in the management of patients with benign gastric ulcer disease. It is most applicable in the high-risk patient who requires operative intervention emergently and, in this circumstance, a decreased mortality rate can be demonstrated and ulcer recurrence is unlikely (2%).