The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer

Autor: S. M. Mishra, M. Y. Sankar, P. Trinder, P. C. Punnen, D. M. Hancock, J. M. Old, A. A. K. Bose, F. X. Lobo
Rok vydání: 1978
Předmět:
Zdroj: British Journal of Surgery. 65:706-711
ISSN: 1365-2168
0007-1323
DOI: 10.1002/bjs.1800651011
Popis: Preoperative oesophageal reflux symptoms have been controlled and the emergence of such symptoms de novo prevented in duodenal ulcer patients by combining proximal gastric vagotomy with a rotational posterior gastropexy. Fifty-two patients having such operations are compared with 46 patients treated by proximal gastric vagotomy (PGV) alone. The two groups match for age, sex and weight but there were more grade 3 refluxers in the group having rotational posterior gastropexy (28) than among those having proximal gastric vagotomy alone (5). Six out of 28 patients in the PGV group who did not have preoperative regurgitation symptoms developed acid brash postoperatively on a 1–6½-year follow-up as against none of 17 patients in the other group. One year follow-up was complete in 94 cases and 57 had a 3·–6½-year follow-up. The 95 per cent confidence limits for cure of grade 3 reflux symptoms by the combined PGV and gastropexy operation were 44·7–88·7 for heartburn and 57·8–97·5 for regurgitation. Postoperative dysphagia can be minimized by attention to a few details during performance of the simple gastropexy procedure. A pentagastrin-glucose pH monitoring test has been devised for this study. When the mean duration of reflux episodes during the 1 h after pentagastrin and the 1 h after 200 ml of 20 per cent glucose is plotted against the number of such episodes, the differences indicate that PGV impairs whilst PGV and gastropexy improves function at the gastro-oesophageal junction. Faber's peak acid output (PAO1) discriminant (Faber et al., 1975) was first used to define positive insulin tests in males. Such positive cases have been reported as having a 50 per cent chance of developing recurrent ulceration. We found that 9 out of 31 patients in the PGV group were positive at 1 year as against 2 out of 28 patients having the combined operation (P
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