Assessment of completeness of vagotomy and surgical experience 10 days and 3 months after proximal gastric vagotomy.

Spontaneous and maximum acid secretion was measured before, and 10 days and 3 months after proximal gastric vagotomy (PGV) to determine the optimal time for testing the completeness of vagotomy. Insulin tests were done 10 days after PGV and it was investigated whether any of the tests could distinguish between experienced and less experienced surgeons. Sixty-eight patients were studied, 38 being operated by experienced and 30 by less experienced surgeons. No significant changes were found in BAO and PAO from 10 days to 3 months after PGV in any of the groups. In contrast to the insulin test results, measurements of BAO and PAO did not discriminate between the two groups of surgeons. However, very incomplete vagotomies according to insulin test results were identified by measurements of PAO 3 months after PGV. It is concluded that early postoperative insulin tests are preferable. The surgeon remembers details of the PGV, the patients is liable to accept the test at this time and insulin tests are more sensitive in discriminating between experienced and less experienced surgeons. Measurements of maximum acid secretion should only replace these tests in patients with cardiac diseases and they should then be performed 3 months after PGV.