Highly selective vagotomy for chronic duodenal ulcer in Jamaicans - abstract

ABSTRACT

Twenty consecutive patients with chronic duodenal ulcer were treated by Highly Selective Vagotomy (HSV) at the University Hospital of the West Indies since June, 1979. Eight had clinical and radiological pyloric stenosis. Their age ranged from 23 to 65 years. There were 15 males and 5 females. All were of African extraction. Gastric acid studies were done on all patients pre-operatively and at 8 days post-operative. In 12 cases the test was repeated. Three months after surgery. At eight days post-operatively, there was a significant reduction in acid secretion basal acid output 53 percentñ113, peak acid output 61 percentñ7, maximal acid output 65 percent5. There was no change between eight days and three months post operatively. Post-operative Hollunder (insulin) test at 8 days and 3 months showed that the vagotomy was complete. At three to seven months follow up, 90 percent patients were found to be symptom free (Visick I), by the surgeon. One patient reported partial relief of pain which required some dietary restraint (Visick II), another who had pre-operative pyloric stenosis improved but developed post-prandial fullness and occasional vomiting (Visick III). There was no mortality and no serious side-effects due to the HSV. However, two patients with pyloric stenosis had reoperation and gastroenterostomy for the relief of gastric stasis. Nineteen patients had gained weight at 3 months (mean 4.6 Kg), and regarded the operation as "very good". We have confirmed that HSV produces adequate reduction in gastric acid output and complete parietal cell denervation. This was sufficient to produce complete relief of duodenal ulcer symptoms in 18/20 (90 percent) of Jamaicans. Better results of HSV were seen when there was no pre-existent pyloroduodenal obstruction. Duodenal ulcer patients with severe symptoms should be offered HSV early before stenosis occurs (AU)