An evaluation of highly selective vagotomy in the treatment of chronic duodenal ulcer.

A randomized trial of highly selective vagotomy against truncal vagotomy and gastroenterostomy has been performed. Forty patients have been analyzed. All operations were performed by one surgeon with previous experience with highly selective vagotomy. Comparisons during the operation indicated that highly selective vagotomy took longer to perform and had a greater associated blood loss. Patients with highly selective vagotomy recovered more rapidly after operation as the duration of ileus postoperatively was shorter. Both operations effectively reduced basal and insulin-stimulated peak acid outputs. At the time of follow-up study, at six weeks and six months postoperatively, patients with highly selective vagotomy had significantly better over-all Visick gradings and had better gradings for the symptom of diarrhea. The differences between the two groups gradually diminished after a year, although diarrhea remained significantly worse in patients who had truncal vagotomy. There were no recurrences of ulcer in either group up to one year postoperatively. Highly selective vagotomy has significant advantages over truncal vagotomy and gastroenterostomy in the immediately postoperative period and up to one year after operation. Only a marked increase in bad results from highly selective vagotomy after a year could justify the continued use of truncal vagotomy and gastroenterostomy.