Postoperative Course in Patients with Perforated and Non-perforated Duodenal Ulcer Following Selective Proximal Vagotomy

Yasumasa Kondoh, Kyoji Ogoshi, Kenji Nakamura, Masao Miyaji, Kunihiro Iwata, Shunsuke Hara, Tomoo Tajima, Toshio Mitomi

Department of Surgery, Tokai University School of Medicine

From 1978 through 1990, 119 patients underwent selective proximal vagotomy for a duodenal ulcer (UD). Indications for surgery were: perforated UD,86; non-perforated UD, 33. Basal acid output, tetragastrin-stimulated gastric secretion (gastrin-MAO), insulin-stimulated gastric secretion (insulin-PAO), gastric emptying test, plasma gastrin levels in response to a test meal and insulin were measured before surgery in patients with non-perforated UD and 3 months to 5 years after surgery in patients with perforated and non-perforated UD. The cumulative recurrence rates were calculated by the Kaplan-Meier method. Plasma gastrin levels after surgery in patients with non-perforated UD were higher than the preoperative levels. Gastric acid secretion levels in patients with perforated UD 1 year after surgery were higher than the 3 months postoperative levels, but the levels over 1 year after surgery were not higher than those 1 year after surgery. Eight of the patients with perforated UD (9.3%) and nine of those with non-perforated UD (27.2%) developed recurrent ulcers and the 10-year cumulative recurrence rates were 26.6% and 31.6% respectively. Patients with a gastrin-MAO value 1 year after surgery of over 20 mEq/h or an insulin-PAO value 1 year after surgery of over 12 mEq/h had higher cumulative recurrence rates than those with a gastrin-MAO value of less than 20 mEq/h or an insulin-PAO value of less than 12 mEq/h. According to these results, patients with high gastrin-MAO and high insulin-PAO levels 1 year after surgery may develop recurrent ulcers.

Key words
selective proximal vagotomy, gastric acid secretion, postoperative recurrent ulcer, perforated duodenal ulcer, gastrin

Reprint requests
Yasumasa Kondoh Department of Surgery, Tokai University School of Medicine
Boseidal, Isehara, 259-11 JAPAN

Accepted
October 7, 1992

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