Long-term results of duodenectomy with highly selective vagotomy in the treatment of complicated duodenal ulcers

Background: Highly selective vagotomy and complete circular or partial duod enectomy have been applied to complicated duodenal ulcer for many years. Th ese procedures seem to provide better clinical results than truncal vagotom y and antrectomy. Methods: A retrospective analysis was conducted of 120 patients with compli cated duodenal ulcer who underwent surgical treatment between 1986 and 1999 . Patients with obstruction were treated with either circular complete (17) or partial duodenectomy (3) combined with highly selective vagotomy or tru ncal vagotomy and antrectomy (37), Those with perforation were treated prim arily with highly selective vagotomy and partial duodenectomy, highly selec tive vagotomy alone, or truncal vagotomy and pyloroplasty. Every patient wa s followed up either by a clinic visit (75%) or questionnaire to determine the presence of ulcer pain, dumping, diarrhea, vomiting, weight loss. and V isick grade. Results: Long-term follow up of patients treated with duodenectomy and high ly selective vagotomy for obstruction showed that 94% had sustained weight gain whereas more than hall. of those treated with truncal vagotomy and ant rectomy had weight loss. In patients with perforation, duodenectomy and hig hly selective vagotomy offered no advantage over highly selective vagotomy alone. Conclusions: Highly selective vagotomy and complete circular or partial duo denectomy provide fewer sequelae and better weight gain long term than trun cal vagotomy and antrectomy for patients with obstructing duodenal ulcers. (C) 2001 Excerpta Medica, Inc. All rights reserved.