THE VALUE OF SHAM-FEEDING TESTS IN PATIENTS WITH POSTGASTRECTOMY SYNDROMES

Objectives The value of gastric secretory testing in surgical practice has been questioned. Sham feeding (SF) is a test of gastric secretion that determines the status of gastric vagal innervation or incomplete vagotomy. Our purpose was to show that the results of SF tests affect operative strategy and/or clinical management. Design: The medical re cords of 30 consecutive patients studied with SF in our laboratory wer e reviewed to determine if patient management was affected by the resu lts of SF. Patients: All 30 patients had prior vagotomies. Sham feedin g was performed in patients (1) before planned reoperation for postgas trectomy syndromes (n=17), (2) with peptic ulcerations/pain of unclear etiology (n=8), or (3) postoperatively in those who were at high risk for recurrent ulcer (n=5). Results: Sham feeding indicated complete v agotomy in 16 patients and incomplete vagotomy in 14 patients. In 17 p atients studied before planned reoperation, operative strategy was aff ected by results of SF in 15 cases; five patients had revagotomies per formed at reoperation, 11 did not, and one patient had her operation c anceled. In patients with atypical postoperative ulcers/pain, manageme nt was changed in only two of eight patients. In the high-risk patient s studied postoperatively, management was affected in four of five pat ients. Conclusions: (1) We believe that our results justify the perfor mance of SF before any reoperation on the stomach, since an operative plan was nearly always affected. (2) In patients with atypical peptic complaints after gastric surgery, SF usually (80%) confirmed acid hype rsecretion, thereby affecting management less often. (3) Although unpr oved, we believe SF results can guide the use of ''prophylactic'' H-2- blockers in treating selected high-risk postgastrectomy patients.