The histology of the gastric mucosa after different types of vagotomy.

Mucosal changes that follow vagotomy may have many causes, including stasis, reflux of small bowel content and the effect of denervation. The effect of stasis was studied using truncal vagotomy without drainage. The main histological feature of stasis when there was clinical evidence of stasis, was superficial ulceration limited mainly to the pyloric antrum. Some chronic gastritis did occur in relation to the areas of ulceration. The effect of reflux was studied using a pyloroplasty without vagotomy. Scattered areas of chronic gastritis usually occurred, again limited mainly to the antrum. The addition of truncal vagotomy did not appear to influence the gastritis. The procedure of anterior highly selective vagotomy was used to examine the effect of denervation without associated reflux or stasis. A characteristic appearance of chief cells has been described, termed the "disappearing chief cell phenomenon" (DCP). Although the DCP occurs in normal mucosa, it may possibly increase after highly selective vagotomy, and represent changes due to the actual denervation of chief cells. After the procedure of anterior highly selective and posterior truncal vagotomy, the mucosa showed no obvious signs either of stasis or of reflux, although the DCP was present. This observation lends support to the view that such a procedure could safely be used in clinical practice. It is less time consuming than bilateral highly selective vagotomy, and does not lead to extensive devascularisation of the lesser curvature.