Proximal gastric vagotomy is nearing its twentieth year in clinical use as an operation for
peptic ulcer disease. No other
acid-reducing operation has undergone as much scrutiny or study. At this time, the evidence of such studies and long-term follow-up strongly supports the use of
proximal gastric vagotomy as the treatment of choice for chronic
duodenal ulcer in patients who have failed medical
therapy. Its application in treating the complications of
peptic ulcer disease, which recently have come to represent an increasingly greater percentage of all operations done for
peptic ulcer disease, is well-tested. However, initial series suggest that it should probably occupy a prominent role in treating some of these complications, particularly in selected patients, in the future. The operation has the well-documented ability to reduce gastric acid production, not inhibit gastric
bicarbonate production, and also minimally inhibit gastric motility. The combination of these physiologic results after
proximal gastric vagotomy, along with preservation of the normal antropyloroduodenal mechanism of gastrointestinal control, serve to allow patients with
proximal gastric vagotomy the improved benefits of significantly fewer severe gastrointestinal side effects than are seen after other operations for
peptic ulcer disease.