This is a progress report of a prospective, randomized study involving 200 consecutive patients treated electively with either
parietal cell vagotomy (PCV) or selective
vagotomy and antrectomy (SV-A). Both groups comprised patients with pyloric, prepyloric, or
duodenal ulcers. There was no operative mortality in either group. Patients were examined at 2, 6, 12 months, and every 12 months thereafter for 8-10 years. The two operations produced no statistical difference in the frequency of
diarrhea. Dumping (p less than 0.0005) and
weight loss (p less than 0.0005-p less than 0.05) were statistically less after PCV than after SV-A. There were two recurrent
ulcers (2.2%) after SV-A. One was treated successfully by medical
therapy and one patient suspected of having
gastrinoma had total
vagotomy. Nine patients had recurrent
ulcers in the PCV group for an accumulated recurrence rate of 10.1%
at 10 years by life-table analysis. There was a significant difference (p less than 0.033) between the curves for recurrent
ulcers in the two groups of patients. The recurrent
ulcer rate after PCV was 21% for patients with pyloric and prepyloric
ulcers and 6% for patients with
duodenal ulcer. There was no significant difference between the recurrent
ulcer rate for PCV and SV-A if the patients with pyloric and prepyloric
ulcers were withdrawn from the study. Of the nine patients with recurrent
ulcers in the PCV group, three had an inadequate
vagotomy and four had a pyloric or prepyloric
ulcer before operation. Three patients were successfully treated with antrectomy. Five patients were treated successfully by medical
therapy and remained healed for long periods without recurrence. One patient had five recurrences. He declined operation and remained free of symptoms for 3 years after his last recurrence. Poor gastric emptying necessitated
gastroenterostomy in five patients in the SV-A group and in one patient in the PCV group. Patients' clinical results were evaluated according to a simple Visick grading scale. A significantly (p less than 0.0005) greater number of patients were in Visick I category after PCV than after SV-A. The clinical results obtained with PCV make this the operation of choice for the elective surgical treatment of
duodenal ulcers even though the results obtained with SV-A were good.