A prospective study evaluating preoperative gastric secretion and choice of an operation for duodenal ulcer.

This study tests the hypothesis that vagotomy and antrectomy are better operations than proximal gastric vagotomy in patients with duodenal ulcer who have a hypersecretion of acid. On the basis of gastric secretion tests preoperatively and the peak acid output, patients with duodenal ulcer were prospectively randomized into an ignore acid or tailor to acid group. Those in the ignore acid group had a proximal gastric vagotomy, while those in the tailored group had a proximal gastric vagotomy if the peak acid output was less than 40 milliequivalents per hour and a vagotomy and antrectomy if the peak acid output was greater than 40 milliequivalents per hour. At follow-up study, a mean of 2.1 years, the recurrence rate in the ignore acid group was 13.6 per cent compared with 9.5 per cent in the tailored group. However, in the ignore acid group, the recurrence rate was 30 per cent if the peak acid output was greater than 40 milliequivalents per hour and zero per cent if less than 40 milliequivalents per hour. In the tailored group, the vagotomy plus antrectomy recurrence rate was 12.5 per cent and the proximal gastric vagotomy rate, 7.7 per cent. Proximal gastric vagotomy has an unacceptably high recurrence rate in patients with a hypersecretion of acid, and selective duodenal ulcer operations based upon acid studies preoperatively may be of value.