The different outcome of duodenal and pyloric channel ulcers after proximal gastric vagotomy. Clinical and morphological results.

Pyloric channel ulcers have a significantly higher recurrence rate than duodenal ulcers after proximal gastric vagotomy (PGV) without drainage. The failure of PGV cannot be explained by the pre- and postoperative secretory pattern of pyloric (PU) and prepyloric (PPU) ulcers. The morphological assessment of the pyloric and antral wall in DU, PU and PPU shows a significant thickening of the muscular layer in PU and PPU compared with DU. Histologically there is a muscular hypertrophy combined with muscular and ganglionic cell damage and fibrosis. The observed antropyloric dystrophy might be one factor for explaining the failure of PGV alone in pyloric channel ulcers. Addition of a drainage procedure for PU or even of a limited antrectomy for PPU might improve the postoperative results and must be discussed when planning surgical treatment of pyloric channel ulcers which seem to characterise as a distinct entity of peptic ulcer disease.