Is an antireflux procedure necessary in conjunction with parietal cell vagotomy in the absence of preoperative reflux?

During a 4 year period, we found no objective evidence that parietal cell vagotomy contributes to the production of gastroesophageal reflux. The fact that patients without reflux preoperatively achieved the same satisfactory clinical results whether parietal cell vagotomy was or was not accompanied by an antireflux procedure supports this view. Therefore, in the absence of reflux, we cannot recommend the prophylactic use of an antireflux procedure in combination with parietal cell vagotomy in the treatment of patients with duodenal ulcer. On the other hand, patients with duodenal ulcer should be evaluated for gastroesophageal reflux before operation because it is desirable to combine parietal cell vagotomy with an antireflux procedure if both conditions exist. Patients who have mild reflux preoperatively but no symptoms of reflux after parietal cell vagotomy alone, as in three of the four patients in Group IV, may have such symptoms subsequently. Therefore, we think that the combined procedure does not increase the morbidity over that of parietal cell vagotomy alone and recommend the combination of parietal cell vagotomy and an antireflux procedure for any patient undergoing operation for duodenal ulcer who also demonstrates an abnormal degree of gastroesophageal reflux.