Reducing the recurrence rate of duodenal ulceration after highly selective vagotomy: a study in the rat and in man.

Acid secretion after highly selective vagotomy (HSV) gradually increases with time and may be related to the rate of duodenal ulcer recurrence following this operation. Studies were carried out in the rat and in man to examine whether preventing recommunication of the vagal branches with their distal stumps reduces the rate of acid secretion recovery and duodenal ulcer recurrence after HSV. Male rats were allocated at random to three groups: (i) sham HSV, (ii) HSV, (iii) HSV with a polytetrafluoroethylene patch stitched against the denervated area of lesser curve. After housing for 2 years, the basal acid output of the HSV group was significantly (P < 0.01) depressed relative to control values (6.9 +/- 0.2 vs 14.1 +/- 0.4 mumole/hr, mean +/- SEM, n = 39 and 40, respectively). HSV with a patch had a basal acid output significantly (P < 0.01) lower than that of the HSV group (1.4 +/- 0.1 mumole/hr, mean +/- SEM, n = 41). Insulin significantly (P < 0.001) stimulated acid secretion in the HSV group but failed to do so in the group provided with a patch (1.4 +/- 0.1 vs 2.3 +/- 0.2 mumole/hr, mean +/- SEM, n = 41). Subcutaneous infusion of pentagastrin (4 micrograms/kg min) and carbachol (0.8 micrograms/kg min) for 24 hr produced duodenal ulceration in all of the control animals and in 20% of those in the HSV group, but in none of the HSV with a patch group.(ABSTRACT TRUNCATED AT 250 WORDS)