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Parietal cell (highly selective or proximal gastric) vagotomy for peptic ulcer disease

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Abstract

Parietal cell vagotomy has been in clinical use for 7 years in elective treatment of nonobstructive duodenal ulcer, and for even a shorter period for complicated cases and for gastric ulcer. The evolution of the surgical technique has not yet come to an end and the ability to perform the procedure is still improving. It can therefore be questioned, if this operation is yet ripe for a realistic clinical trial, and the great variation in recurrence rate reported in pilot series as well as in prospective randomized clinical trials points to the possibility that we will have to wait several years before the anticipated mean recurrence rate is known. At present it can be stated that even if gastric emptying is not quite undisturbed, the addition of a drainage procedure in nonobstructive cases is unnecessary. The same may be true in some patients with pyloric obstruction. Furthermore, the mortality rate is very low and the incidence of moderate-to-severe dumping and diarrhea is virtually nil.

Résumé

La vaguotomie supra-sélective des cellules pariétales est employée en clinique depuis seulement sept ans dans le traitement électif des ulcères duodénaux non-compliqués d'obstruction; son emploi dans le cas d'ulcères duodénaux compliqués et d'ulcères gastriques est encore plus récent. La technique chirurgicale continue d'évoluer et de se perfectionner. On peut donc se demander s'il est opportun pour le moment de soumettre cette opération à une étude clinique controlée; la grande variabilité rapportée dans les taux de récidive lors des études pilotes aussi bien que des études prospectives laisse supposer qu'il faudra attendre plusieurs années avant que le véritable taux moyen de récidive soit connu. Pour le moment on peut dire que mÊme si la vidange gastrique est légèrement affectée, l'addition d'une procédure de drainage n'est pas nécessaire dans les cas non compliqués d'obstruction. Il se peut mÊme que cette observation s'applique aussi à certains patients porteurs d'obstruction pylorique. De plus, le taux de mortalité est bas, et l'incidence de diarrhée postopératoire et de syndrome de chasse gastrique (“dumping”) modéré ou sévère est pratiquement nulle.

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Authors and Affiliations

  1. Department of Surgery, University of Aarhus, Aarhus, Denmark

    Erik Amdrup M.D., Ph.D., Daniel Andersen M.D., Ph.D. & Hans -Eric Jensen M.D., Ph.D.

  2. Department of Surgery, Kommunehospitalet, Copenhagen, Denmark

    Erik Amdrup M.D., Ph.D., Daniel Andersen M.D., Ph.D. & Hans -Eric Jensen M.D., Ph.D.

Authors
  1. Erik Amdrup M.D., Ph.D.
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  2. Daniel Andersen M.D., Ph.D.
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  3. Hans -Eric Jensen M.D., Ph.D.
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Amdrup, E., Andersen, D. & Jensen, H.E. Parietal cell (highly selective or proximal gastric) vagotomy for peptic ulcer disease. World J. Surg. 1, 19–25 (1977). https://doi.org/10.1007/BF01654722

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