Vagotomy and pyloroplasty in the treatment of duodenal ulceration. Long-term results.

In the years 1960 through 1966, vagotomy and pyloroplasty was performed for duodenal ulceration in 182 patients. Elective operation was performed in 84% of cases, and intractability of symptoms was the major indication. For emergency operations, bleeding was the main indication. Eight of 182 patients died in the postoperative period (operative mortality 4.4%--3.3% elective, 10.3% emergency). Follow-up of 1 to 17 years has been obtained in 154 of 182 patients (96% of these from 5 to 17 years). Ulcer recurred in 12.3% of cases (13.6% elective, 4.5% emergency); the average time to recurrence was 4.8 years. Fully 37% of recurrent ulcers were documented 6 years or more postoperatively. Morbidity was significant; diarrhea and "dumping" were the most noteworthy sequelae, and these occurred in 16.2% and 7.8% of cases, respectively. "Postgastrectomy sequelae" occurred in 61 of 154 patients. It is concluded from this study that vagotomy and phyloroplasty, as currently practiced and used in the elective surgical treatment of chronic duodenal ulceration, does not sufficiently protect against recurrence of ulcer.