Complete Vagotomy and Its Consequences: Follow-up of 146 Patients.

Division of all vagal branches to the stomach may be important in the treatment of duodenal ulcer. As long ago as 1947 Dragstedt and his colleagues pointed out that if a branch of the vagus is inadvertently missed at operation there may be reactivation of the whole of the glandular apparatus, return of high acid secretion, and consequent recurrence of ulceration; more recently Murray (1962a) discussed the mechanism of return of nervous activity. In 1958 Burge and Vane introduced a method of testing for completeness of vagal section at the time of operation, and Clark and Murray (1963) investigated the usefulness of the test in 100 patients. This report is concerned with a follow-up from two to five years after operation in which " complete vagotomy " was carried out. In all cases the drainage procedure was gastro-enterostomy. An attempt has been made to answer a number of questions. Does complete vagotomy confer an immunity from recurrence of ulceration ? How does morbidity after complete vagotomy compare with that after incomplete nerve section and after partial gastrectomy ? A question of a different kind is whether it is possible to select the appropriate surgical treatment for an individual patient on the basis of pre-operative gastric secretory studies. Bruce et al. (1959), Gillespie and Kay (1961), and Orr (1963) believe that the augmented histamine test is useful in indicating which patients are best treated by vagotomy. The results in the series have been studied to see if there is support for this view.