A new test for complete nerve section during vagotomy

Abstract

Abstract A new test of completeness of vagotomy based upon the evaluation of pH variations in the stomach is presented. The test is performed during the operation through a minimal gastrotomy with a glass electrode after vagotomy and maximal histaminic stimulatin. In order to avoid errors a study of 28 ulcer patients had been performed previously. This study showed that under general anaesthesia with unsectioned vagi the pH can be used to evaluate the variations of gastric secretion, that there is no basal secretion, and that the maximal histminic test is able to stimulate the acidsecreting cells. The test performed later in 40 patients showed a completed denervation as demonstrated by pH values between 5·5 and 7 on the whole mucous gastric surface in 36 patients, while in 4 patients the presence of a limited zone of gastric mucosa with a pH of 1·2–2 surrounded by mucosa with a pH between 5·5 and 7 showed not only an incomplete vagotomy but also, on the basis of their localization on the wall of the stomach, whether the unsectioned branches were anterior or posterior. Furthermore, the test performed in four series of patients, in which the vagotomy was left temporarily incomplete on purpose, showed that the presence of more than one acid zone in the gastric mucosa was due to one unsectioned fibre of the oesophageal plexus, while in the case of a single acid zone it was due to a terminal gastric branch. Long-term follow-up (up to 1 year after the operation) showed that after amaximal histaminic tests the values found were similar to those found intraoperatively, and after Hollander tests, values for complete vagotomy without so-called “adequate vagotomies” were found.