Posterior truncal vagotomy and stapling of the anterior stomach wall in 30 patients with duodenal ulcer: acid inhibition, gastric emptying, and endoscopic dye spraying. Prospects for endoscopic vagotomy.

The use of a stapling instrument (TA90) to effect a transection of the anterior gastric wall with posterior truncal vagotomy but preserving innervation to the anterior wall of the antrum for duodenal ulcer is described. The operation resulted in the endoscopic healing of all the ulcers; however, recurrent ulceration was seen in 3 of 25 patients. Basal acid output was reduced from 7.84 (SEM 1.73) to 3.49 (SEM 1.15) mmol/h (t = 2.09, df = 15.7, p = 0.05), while peak acid output was reduced from 38.67 (SEM 3.11) to 19.26 (SEM 2.3) mmol/h (t = 5.01, df = 23.9, p = 0.0000). Solid and liquid gastric emptying studies were performed, and while some delay in solid emptying was seen, only one patient complained of transient gastric stasis. Endoscopic Congo red staining was performed postoperatively and a tongue of innervated mucosa along the lesser curve was seen in each case. The procedure was easily and rapidly performed, and early clinical results are good, with 25 of 30 patients having a good (Visick I) result.