Long term results of truncal vagotomy and [uncut] roux gastrojejunostomy for management of chronic duodenal ulcer with reference to gastric emptying

ABSTRACT

In the previous reports, we described the surgical technique of truncal vagotomy and "uncut" Roux gastro-jejunostomy [TV+UCRGJ] in management of chronic duodenal ulcer [CDU]. Also, we demonstrated that it is not associated with significant increase in postoperative enterogastric reflux [EGR]. This work represents the long-term results of TV+UCRGJ, with assessment of gastric emptying using gastro-hydro-sonography. Fifty two patients, [mean age 47.21+12.89 years], with CDU were managed by TV+UCRGJ and were followed-up for a mean duration of 54.71 +/- 9.21 months, for symptomatic outcome. Gastric emptying for semisolids was assessed ultrasonographically, by measuring the percent change of the post-prandial gastric antral area [AA] in patients, pre and at least 12 months post-operative. The results were compared to 50 matching controls. Excellent or fair symptomatic outcome was described by 47 patients [90.3%]. Four patients [7.7%] needed redo gastric surgery, two with ARG [one due to stapler line dehiscence] and two with severe gastric stasis. There was a significant drop in the mean preoperative symptomatic score, following surgery [2.98 +/- 0.92 Vs 0.827 +/- 1.279, p=0.000], to a figure matching the controls [0.827 +/- 1.279 Vs 0.667 +/- 1.046, p=0.514]. Ultrasonographic assessment of gastric emptying, showed insignificant difference in gatric emptying percent at 30 minutes between postoperative and controls values [66.73 +/- 11.75% Vs. 70.19 +/- 10.27%, P=0.810]. As well, there was insignificant difference between post and preoperative values [66.73 +/- 11.75% Vs. 69.85 +/- 11.88%, p=0.074]. Truncal vagotomy and "Uncut" Roux gastrojejunostomy carries good long-term symptomatic and functional outcome. Also, it is associated with normal gastric emptying. So, it can be included as an initial surgical option in the management of uncomplicated CDU