Selection of operation for duodenal ulcer based on acid secretory studies—A reappraisal

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Abstract
The incidence of recurrent duodenal or jejunal ulceration was assessed 5–10 years after selective surgery for duodenal ulceration in 253 patients after vagotomy and drainage and in 55 patients after vagotomy and antrectomy. In the vagotomy and drainage group 8.6 per cent of the patients developed proven or highly suspected recurrent duodenal or jejunal ulcer. None of these patients had preoperative maximal acid output (M.A.O.) values less than 25 mEq. per hour. No recurrent jejunal ulcers occurred in the vagotomy and antrectomy group despite the fact that they had the same incidence of incomplete vagotomy by Hollander's criteria as the vagotomy and drainage group. It is suggested that a policy of selection of patients for vagotomy and drainage based on a preoperative M.A.O. of 25 mEq. per hour seems more justified and realistic than the previously used level of 40–50 mEq. per hour. Vagotomy and antrectomy should probably be employed if the M.A.O. is greater than 25 mEq. per hour.