[Perfection of the method of selective proximal vagotomy and improvement of late-term results of the surgical treatment of duodenal ulcer].

In the period from 1985 to Sept. 1990 operations were conducted on 288 patients with duodenal ulcer; 165 of these patients (group I) were treated by selective proximal vagotomy (SPV) by the old method--without extensive mobilization of the cardia, esophagus, and fundus of the stomach; draining operations were used in 97% of patients. A perfected operative method was applied in 123 patients (group II)--besides extensive dissection of the zone of the esophagogastric junction all of them underwent circular esophagomyotomy 2 cm above the cardia and modified fundoplication. The indications for draining operations were limited (51.2% of patients). The results studied in 2.3 patients in follow-up periods of 6 months to 5 years confirmed the advantages of the perfected method of SPV: the number of recurrent ulcers reduced from 11.8% to 1.7%, that of the dumping syndrome from 9.2% to 4.5%, and the incidence of diarrhea from 7.8% to 3.3%. In groups I and II the results were excellent and good in 66.7% and 88.3% of patients, satisfactory in 21.6% and 10.0% of patients, and poor in 11.8% and 1.7% of cases, respectively. Perfection of the SPV method is directly reflected in its results which must be studied in follow-up periods of over 5-10 years for the evaluation to be more objective.