[20 years of vagotomy: indications and choice of procedure--duodenal ulcer].

At present proximal gastric vagotomy is the best long-term therapy for duodenal ulcer. It is indicated in cases in which conservative treatment has failed. Controlled studies in the context of this surgical approach have shown the average rate of recurrence to be about 17 per cent. Inadequate acid reduction due to incomplete proximal gastric vagotomy (PGV) has proved to be the most common cause of postoperative recurrence of ulcer. The extent of distal skeletisation is considered to be a weak point of PGV and is discussed with reference to technical modifications, in particular pyloroplasty. Postoperative quality checks were found to be useful in providing information on whether the therapeutic purpose of PGV has been accomplished or if the patient should be associated with a high-risk group of ulcer recurrence. Preliminary results obtained from intragastric long-term pH-metry appear to support hopes for better postoperative differentiation.