Should cholecystectomy be combined with vagotomy and pyloroplasty?

Duodenal ulcers and gallstones, two of the commonest surgical conditions, affect respectively 10% of men and up to 20% of the population. Although many detailed studies of the treatment of these conditions have been conducted, there is no report of the results of surgery when the conditions coexist. 60 patients who had undergone vagotomy, pyloroplasty, and cholecystectomy were compared with age and sex matched controls who had undergone vagotomy and pyloroplasty alone or cholecystectomy alone. In the early postoperative period after the combined procedure there was a very high incidence of post-vagotomy diarrhoea (48.3%, P equal to 0.00013) and bile-reflux gastritis. The findings implicate bile-acids--their excretion and handling by the small intestine--in the aetiology of post-vagotomy diarrhoea. Where the conditions coexist truncal vagotomy and pyloroplasty should be avoided in the treatment of the duodenal ulcer because of the risk of post-vagotomy diarrhoea and bile-reflux gastritis.