Follow‐up of 100 patients five to eight years after parietal cell vagotomy

Recurrent ulcer developed in 9 out of 100 patients followed up for 5 to 8 years after parietal cell vagotomy (PCV) for duodenal ulcer. The time of recurrence was often surprisingly late, the latest occurring in the 6th year. Patients with recurrence did not differ significantly from the total group...

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Bibliographic Details
Published in:World journal of surgery 1978-07, Vol.2 (4), p.525-530
Main Authors: Jensen, Hans‐Eric, Amdrup, Erik
Format: Article
Language:English
Subjects:
Acid Secretion
Clinical Assessment
Dumping Syndrome - epidemiology
Duodenal Ulcer
Duodenal Ulcer - etiology
Duodenal Ulcer - surgery
Female
Follow-Up Studies
Gastric Acid
Humans
Male
Recurrence
Salicylate
Stomach Ulcer - etiology
Stomach Ulcer - surgery
Time Factors
Vagotomy - adverse effects
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Summary:Recurrent ulcer developed in 9 out of 100 patients followed up for 5 to 8 years after parietal cell vagotomy (PCV) for duodenal ulcer. The time of recurrence was often surprisingly late, the latest occurring in the 6th year. Patients with recurrence did not differ significantly from the total group of patients with respect to sex, preoperative age, weight, or gastric acid secretion. Patients with recurrent ulcer were evenly distributed among the surgeons who performed the operations, and showed no obvious difference in reduction in spontaneous or in pentagastrin‐ and insulin‐stimulated acid secretion, compared to the symptom‐free patients. In 3 patients recurrence might have been related to abuse of salicylates and tobacco, and possibly to mental stress. These ulcers healed in response to nonsurgical treatment and the patients have remained symptom free for several years. In 6 patients, antrectomy was required. Sequelae occurred very infrequently, but in 1 patient dumping complaints were severe. An overall clinical assessment by Visick grading placed 72 patients in grade I, 14 in grade II, 4 in grade III, and 10 in grade IV. The failures included 6 patients who required reoperation for recurrent ulcer, 2 who required reoperation for gastric stasis, and the patient with severe dumping. Résumé Sur 100 malades opérés de vagotomie pariétale pour ulcère duodénal et suivis pendant 5–8 ans, 9 ont présenté une récidive ulcéreuse. La récidive est parfois apparue étonnamment tard, jusqu'à 6 ans après la vagotomie. Il n'y a pas de différence significative entre les patients avec et sans récidive aux points de vue sexe, âge pré‐opératoire, poids, chirurgien responsable de l'opération, sécrétion gastrique préopératoire et réduction postopératoire de cette sécrétion (basale, après pentagastrine, après insuline). Dans 3 cas, la récidive est peut‐être en rapport avec un abus de salicylés, de tabac, ou avec un état de stress psychologique. Ces ulcères ont guéri sous traitement médical et ces malades sont restés sans symptome pendant plusieurs années. Une antrectomie a dû être réalisée chez 6 malades. Les séquelles ont été très rares, mais 1 malade a eu un dumping grave. L'appréciation clinique globale, selon la classification de Visick, est: 72 grade I, 14 grade II, 4 grade III et 10 grade IV. Les échecs comportent les 6 réinterventions pour récidive ulcéreuse, 2 opérations pour stase gastrique et 1 dumping grave.
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01563693