METAANALYSIS OF HIGHLY SELECTIVE VAGOTOMY VERSUS TRUNCAL VAGOTOMY ANDPYLOROPLASTY IN THE SURGICAL-TREATMENT OF UNCOMPLICATED DUODENAL-ULCER

Objective: To compare critically by meta-analysis the postoperative ou tcomes after truncal vagotomy and pyloroplasty (TVP) and after highly selective vagotomy (HSV). Data Sources: A search was conducted on MEDL INE with the keywords ''peptic ulcer'' and ''vagotomy.'' Bibliographie s of the articles retrieved and review articles pertaining to the subj ect were scanned further. Study Selection: Included were only publishe d prospective, randomized controlled trials comparing TVP and HSV in t he English-language literature up to April 1991. Twelve studies were f ound. Data Extraction: Two authors, working independently, abstracted raw data on: mortality, recurrence, dumping, diarrhea and postoperativ e Visick grading. Data Synthesis: A ratio greater than 1.0 indicates a higher proportion occurring with TVP and less than 1.0 a higher propo rtion with HSV. Outcome Odds Ratio Confidence interval Comment Mortali ty 0.68 0.23-1.99 Universally low Recurrence 0.62 0.45-0.84 Favours TV P Dumping 4.52 2.60-7.80 Strongly favours HSV Diarrhea 3.15 2.05-4.82 Strongly favours HSV Visick I vs. II 0.48 0.36-0.64 Excellent results, better with HSV Conclusion: The results suggest that the likelihood o f adverse long-term sequelae is higher with TVP whereas the likelihood of recurrence is higher with HSV.