Anterior seromyotomy and posterior truncal vagotomy--technique and early results of a randomized trial.

Anterior lesser curve seromyotomy with posterior truncal vagotomy (AS + PT) is a new operation for the treatment of chronic duodenal ulcer. Since April 1981 this technique was carried out in 84 patients for three different conditions: chronic duodenal ulcer (N = 48), perforated duodenal ulcer (N = 18) and as an additional procedure in Nissen fundoplication for reflux oesophagitis (N = 18). The surgical technique is described in detail. In the treatment of chronic duodenal ulcer, AS + PT has been compared to proximal gastric vagotomy (PGV) in a randomized clinical trial. 51 Patients (PGV: 26; AS + PT: 25) have been followed up for more than 1 1/2 years. Satisfactory clinical results (Visick grades I + II) were found in 88.5% of patients after PGV and in 92.7% after AS + PT. Basal acid output (BAO) was reduced by 70.2% after PGV and 85.7% after AS + PT, whereas the reduction in pentagastrin stimulated peak acid output (PAO) was 54.2% and 58.9% respectively. Neither in the chronic duodenal ulcer group nor in the two other groups of patients treated by AS + PT were serious postoperative gastric sequelae encountered. The results of this randomized trial suggest that AS + PT is at least as good as PGV in the surgical treatment of chronic duodenal ulcer. We anticipate that AS + PT, which is technically simpler and less time consuming than PGV, will replace PGV as the procedure of choice in the surgical treatment of chronic duodenal ulcer.