Proximal gastric vagotomy with suprapyloric mucosal antrectomy for duodenal ulcer.

The feasibility of doing proximal gastric vagotomy with suprapyloric mucosal antrectomy for duodenal ulcer was investigated in a pilot study of seven patients. The aim was to reduce the risk of recurrent duodenal ulcer after proximal gastric vagotomy without causing a simultaneous increase of the risk of dumping and diarrhoea. The patients were subjected to pre- and early postoperative gastric secretory tests, radiologic and endoscopic examinations of gastric motility 2 months later, and a clinical follow-up 1 year after the operation. Basal and maximum acid secretion was reduced by 86 and 70% in average in 6 patients. One patient developed mild dumping. Neither recurrent duodenal ulcer nor diarrhoea was accounted. However, 3 patients developed severe gastric stasis and 2 of these had to be reoperated, one having an anastomotic ulcer between fundic and suprapyloric mucosa. The results of this rather timeconsuming and tedious operation did not encourage further trial, but suggested proximal gastric vagotomy alone as being the operation of choice for duodenal ulcer without pyloric or duodenal stenosis.