The value of preserving the pylorus in the surgery of duodenal ulcer

Abstract

Abstract Highly selective vagotomy without a drainage procedure (H.S.V.) has been use in the surgical treatment of 120 cases of duodenal ulcer in Leeds over the past 3 years. In this operation preservation of the vagal nerve-supply to the antral region of the stomach permits preservation of an intact pylorus. In the present paper the results which have been achieved are assessed, both clinically and experimentally, by comparison with the results in patients after truncal or selective vagotomy and pyloroplasty at a comparable stage after operation. Studies of gastric emptying provide no evidence of gastric stasis after H.S.V., and symptoms of flatulence and food vomiting are found no more frequently than after vagotomy and pyloroplasty. After both truncal and selective vagotomy and pyloroplasty gastric emptying and small-bowel transit were abnormally fast, whereas after H.S.V. there was much less departure from the values found in preoperative ulcer patients. At the clinical and experimental level dumping and diarrhoea were singnificantly less frequent after H.S.V. than after vagotomy and pyloroplasty. To date there has been no operative mortality, no case of recurrent ulcer, and no reoperation for gastric stasis after H.S.V. Preservation of a more normal pattern of gastric emptying, by reducing the incidence of dumping, diarrhoea, and bile vomiting, has led to better overall (Visick) results after H.S.V. than after truncal or selective vagotomy and pyloroplasty.