Evaluation of proximal gastric vagotomy with mucosal antrectomy in the treatment of chronic duodenal ulcer

ABSTRACT

Proximal gastric vagotomy and mucosal antrectomy with mucosal corporal-pyloric anastomosis was done to 20 patients with uncomplicated duodenal ulcer. Proximal gastric vagotomy was performed according to the conventional technique. Mucosal antrectomy was performed by excising the antral mucosa via a circular corporal seromyotomy, removing a circumferential band of the corporal seromuscularis anastomosing the corporal and pyloric mucosae endoantrally, and reapproximating the corporal and antral seromuscular layers. Postoperative insulin test was found negative in 19 patients denoting complete denervation. The operation induced 90% reduction of BAO and 76.5% reduction of MAO. The overall Visik grading of functional results of the operation revealed that at two months, 75% were Visik grade I, 20% grade II and 5% grade IV. Six months to two years after the operation, 85% were grade I, 5% grade II, 5% grade III and 5% grade IV [one patient with persistent ulcer]. Because of the denervation of the parietal cell mass by proximal gastric vagotomy and great reduction of the gastric acid secreting mechanism by mucosal antrectomy, the results of this operation is highly effective in ulcer healing