Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5--9-year follow-up.

From 1970 to 1974 proximal gastric vagotomy without drainage was performed in 158 patients for duodenal ulcer. One patient died, giving an operative mortality of 0.6 per cent. Nine unrelated deaths occurred during the period of survey and 5 other patients were lost to follow-up. The remaining 143 patients were followed-up for a minimum of 5 years and a maximum of 9 years. The most frequent symptoms were epigastric fullness and intolerance to milk. Early dumping, detected in 6.7 per cent of the patients, was always mild. Diarrhoea, also very slight and often only related to the ingestion of milk, was seen in 9.6 per cent. Recurrent duodenal ulcer was proved in 7.7 per cent and strongly suspected in 0.7 per cent and the presence of a new gastric ulcer was also proved in 1.4 per cent of patients, making a total incidence of recurrence of 9.8 per cent. Approximately 89 per cent of the patients were classed as having a satisfactory result and 11 per cent were classed as unsatisfactory. Proximal gastric vagotomy is clearly effective in reducing the side effects of gastric surgery, while the incidence of recurrent ulceration in the long term is similar to the incidence of recurrence after truncal or selective vagotomy with a drainage procedure. For these reasons, consideration should be given to the wider use of proximal gastric vagotomy in the elective surgical treatment of duodenal ulcer.