Proximal Gastric Vagotomy and Duodenoplasty for Stenotic Duodenal Ulcers – Long-Term Results

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Abstract
Between 1975 and 1984, 39 patients with duodenal ulcer (DU) and stenosis causing gastric outlet obstruction were operated on with a proximal gastric vagotomy (PGV) and a duodenoplasty. This technique consists of a longitudinal incision made at the site of the duodenal narrowing, followed by a transverse suture. It enlarges only the narrowed duodenum but leaves the important pyloric ring intact. The mean observation time was 70 months (extremes: 18 months and 11 years). There was no operative mortality. The clinical results were excellent or good in 95 % of the patients (Visick I and II). After the operation no patient had symptoms of gastric retention, dumping or diarrhea. No recurrent stenosis has occurred. Only 1 patient (2.5%) developed a recurrent ulcer 5 years after the operation. It is concluded that duodenoplasty is a good operation in patients with stenotic DU. It corrects the narrowing and preserves the pyloric function. The combination of PGV and duodenoplasty in stenotic DU yields an incidence of ulcer recurrence comparable to that observed in our hands after PGV alone for nonstenotic DU (5/146 – 3.5%). It is assumed that the systematic control and treatment by duodenoplasty of every partial duodenal stenosis may have contributed to the low incidence of ulcer recurrence after PGV (6/185 – 3.2%) in our series by eliminating a possible residual stasis. This assumption remains to be proven.

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