Expedient surgical treatment of chronic ulcer stenosis. A case for proximal gastric vagotomy.

Forty-nine patients with chronic pyloroduodenal ulcer stenosis were treated surgically in our hospitals between 1977 and 1985. Three operations were used: 16 patients had a proximal gastric vagotomy-pyloroplasty (PGV-P); 26 had a vagotomy-antrectomy (V-A); and seven had a truncal vagotomy-pyloroplasty (TV-P). Historical data and preparations for operation were similar in each group. We compared the early clinical outcome in these patients. Two patients died after V-A and one died after TV-P. Five patients were reoperated: V-A (three patients), PGV-P and TV-P (one patient each). Delayed gastric emptying with nonoperative resolution (DGE) occurred in nine patients after V-A and in two patients after TV-P. Preoperative gastric suction and parenteral nutrition did not avoid DGE or affect timing of return to a general diet. A solid diet was resumed earlier (p less than 0.01) after PGV-P (5 +/- 1 days) than after V-A (13 +/- 8 days) or TV-P (9 +/- 2 days). Ninety-four percent of patients after PGV-P had an uneventful recovery, compared with 46 and 43% after V-A and TV-P, respectively. Among the variables measured, operative choice of PGV-P expedited early surgical recovery of patients with chronic ulcer stenosis.