Evaluation of the different surgical techniques for treatment of chronic duodenal ulcer

ABSTRACT

In a prospective controlled clinical trial, 59 patients with chronic duodenal ulcer, in whom surgery was indicated, were randomly allocated into 3 treatment groups. The first group [21 patients] was treated by truncal vagotomy with gastrojejunostomy [TV+GJ], the second group [20 patients] was treated by proximal gastric vagotomy [PGV], and the third group was treated by truncal vagotomy and antrectomy [TV+A]. There was no mortality after any of the three operations. Significantly raped rectum of gastric emptying occurred after PGV, followed by TV+GJ and lastly TV+A. Postoperative upper GI endoscopy, done 4 weeks after surgery, showed that bile reflux and gastritis were highest after TV+GJ, followed by TV+A lastly PGV. The differences in the endoscopic findings, between TV+GJ and PGV, were significant. Biochemical assessment of the patients, 4 weeks after surgery showed significant decrease n the basal, maximum and peak gastric acid output after each of the three operation. There was no statistical difference in the reduction between TV+GJ and PGV, whereas the reduction after TV+A was significantly greater than after TV+GJ or PGV. If reduction of gastric acidity is the only concern, then TV+A, undoubtedly, stands out. Nevertheless if vagotomy is adopted [because of the high operation mortality and morbidity, and the longterm adverse effects of gastroctomy documented by other studies], then PGV is recommended as the first choice, since it gave, in this study, the same degree of acid reduction as TV+GJ, it should, presumably, results in the same cure rate. In the mean time it was associated with less shortcomings in the early postoperative assessment