The surgical treatment of duodenal ulcer.

Based on experience of a pilot series of 100 patients treated by parietal cell vagotomy (PCV) and a prospective clinical comparison between PCV (in some cases with drainage added) and selective gastric vagotomy (SGV) with drainage (D) or antrectomy (A) in some 900 patients, the following conclusions can be drawn: PCV is followed by virtually no sequelae. When drainage is added this is no longer the case and the results are the same as those following SGV + D. PCV and SGV + D show the same recurrence rate at 3 years (approx. 7%). Men do better than women after PCV but not after SGV + D. Preoperative gastric acid secretion had no predictive value in these studies. In non-obstructing duodenal ulcer the surgical choice appears to be between PCV (no sequelae) and SGV + A (no recurrence). The optimal operation for prepyloric ulcer cannot as yet be determined.