From August, 1970 to February, 1989, we performed 1,105 elective and 145 emergency PGVs (
proximal gastric vagotomy). The emergent cases included 118 perforations and 27
bleeding lesions. Since September, 1973, we have been able to measure the pH of the mucosa using a GR282C transesophageal
electrode. Two cases of exitus (0.2%) were noted. With an intraoperative test (pH) or the systematic section of the gastroepiploic nerve (
n.ge) (randomized with 269 cases followed up over 57 months) the rate of recurrence does not exceed 2%. Without these "tools", it is as high as 10%. Since this rate is still a cause of
confusion in this 20th year of PGV, we analyse 684 "stabilized" (excluding the first 10 patients of each surgeon). PGVs followed up (88% of 777 PGVs) over 10 to 17 years. The study was clinical and radiological in 100% of cases, based on
acid secretion in 2/3, and fiberscopic in 47%. Between 5 and 17 years, 318 patients had a fiberscopic study and 325 an analysis of the basal and stimulated
acid secretion (76% were already evaluated preoperatively). Two types of recurrence were defined: those due to failure of the surgeon or technique (gastroepiploic nerve in 1/5 of cases) involving acidity--this being the "persistent"
ulcer (3/4 of cases during the first years); and disorders in gastric evacuation (?) with a very low acidity level, also causing more delayed
gastric ulcers. The non-cumulative probability of R in successive years stays around 0.2 to 0.1% after the 3rd or 4th year following the PGV, and the total rate after 10 years or more is about 10%. If performed by experienced surgeons and with the intraoperative test (or systematic section of the
n.ge), PGV should have only a low rate of failure, these cases being more amenable to treatment than an anastomotic
mouth ulcer following resection, for instance.