Skip to main content
PMC home page
Gut logoLink to Gut
. 1973 Apr;14(4):300–307. doi: 10.1136/gut.14.4.300

The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man

R J Clarke, J Alexander-Williams
PMCID: PMC1412602  PMID: 4706912

Abstract

A prospective randomized trial of 40 duodenal ulcer patients is reviewed. The patients had one of four operations (selective vagotomy, proximal gastric vagotomy, selective vagotomy plus pyloroplasty, or proximal gastric vagotomy plus pyloroplasty). The gastric emptying of a hypertonic fluid meal was assessed before and three to four months after operation. Selective vagotomy without a drainage procedure results in gastric retention and should no longer be considered as a method of treatment for duodenal ulcer. Proximal gastric vagotomy without a drainage procedure does not lead to gastric retention. Initial gastric emptying is more rapid after proximal gastric vagotomy but the final emptying time is the same as before operation and this operation alters the pattern of gastric emptying less than the other operations. Pyloroplasty added to either selective or proximal gastric vagotomy results in loss of the normal regulation of gastric emptying, very rapid initial gastric emptying, and a significant increase in the incidence of `dumping'. It appears from these studies that `dumping' is due to rapid gastric emptying and mainly due to the drainage procedure.

Full text

PDF
302

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amdrup B. M., Griffih C. A. Selective vagotomy of the parietal cell mass: Part I: With preservation of the innervated antrum and pylorus. Ann Surg. 1969 Aug;170(2):207–214. doi: 10.1097/00000658-196908000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Amdrup E., Jensen H. E. Selective vagotomy of the parietal cell mass preserving innervation of the undrained antrum. A preliminary report of results in patients with duodenal ulcer. Gastroenterology. 1970 Oct;59(4):522–527. [PubMed] [Google Scholar]
  3. Amdrup E., Johnston D., Goligher J. C. 110 highly selective vagotomies without drainage (HSV) for duodenal ulcer. Gut. 1970 Dec;11(12):1062–1062. [PubMed] [Google Scholar]
  4. BURGE H., VANE J. R. Method of testing for complete nerve section during vagotomy. Br Med J. 1958 Mar 15;1(5071):615–618. doi: 10.1136/bmj.1.5071.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burge H., MacLean C., Stedeford R., Pinn G., Hollanders D. Selective vagotomy without drainage. An interim report. Br Med J. 1969 Sep 20;3(5672):690–693. doi: 10.1136/bmj.3.5672.690. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Clarke R. J., Allan R. N., Alexander-Williams J. The effect of retaining antral innervation on the reductions of gastric acid and pepsin secretion after vagotomy. Gut. 1972 Nov;13(11):894–899. doi: 10.1136/gut.13.11.894. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Clarke R. J., McFarland J. B., Williams J. A. Gastric stasis and gastric ulcer after selective vagotomy without a drainage procedure. Br Med J. 1972 Feb 26;1(5799):538–539. doi: 10.1136/bmj.1.5799.538. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Clarke R. J., Williams J. A. The value of phenol red and chromic chloride as nonabsorbable gastric indicators. Gut. 1971 May;12(5):389–392. doi: 10.1136/gut.12.5.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cobb J. S., Bank S., Marks I. N., Louw J. H. Gastric emptying after vagotomy and pyloroplasty. Relation to some postoperative sequelae. Am J Dig Dis. 1971 Mar;16(3):207–215. doi: 10.1007/BF02235241. [DOI] [PubMed] [Google Scholar]
  10. Colmer M. R. Dumping after vagotomy and pyloroplasty. Ann R Coll Surg Engl. 1971 Jan;48(1):5–6. [PMC free article] [PubMed] [Google Scholar]
  11. FENGER H. J. THE DUMPING SYNDROME AND GASTRIC EMPTYING WITH A DISCUSSION ON THE MEDICAL AND SURGICAL TREATMENT. Acta Chir Scand. 1965 Jan;129:86–95. [PubMed] [Google Scholar]
  12. George J. D. New clinical method for measuring the rate of gastric emptying: the double sampling test meal. Gut. 1968 Apr;9(2):237–242. doi: 10.1136/gut.9.2.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Goligher J. C., Pulvertaft C. N., Irvin T. T., Johnston D., Walder B., Hall R. A., Willson-Pepper J., Matheson T. S. Five- to eight-year results of truncal vagotomy and pyloroplasty for duodenal ulcer. Br Med J. 1972 Jan 1;1(5791):7–13. doi: 10.1136/bmj.1.5791.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hinshaw D. B., Thompson R. J., Jr, Branson B. W. Pre- and postoperative "dumping studies" in patients with peptic ulcer. Am J Surg. 1971 Aug;122(2):269–274. doi: 10.1016/0002-9610(71)90329-1. [DOI] [PubMed] [Google Scholar]
  15. Humphrey C. S., Wilkinson A. R., Johnston D. The correlation between the rate of gastric emptying and dumping and diarrhoea after truncal, selective, and highly selective vagotomy. Br J Surg. 1972 Apr;59(4):309–309. [PubMed] [Google Scholar]
  16. Interone C. V., Del Finado J. E., Miller B., Bombeck T., Nyhus L. M. Parietal cell vagotomy. Studies of gastric emptying and observations of protection from histamine-induced ulcer. Arch Surg. 1971 Jan;102(1):43–44. doi: 10.1001/archsurg.1971.01350010045011. [DOI] [PubMed] [Google Scholar]
  17. Johnston D., Wilkinson A. R. Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer. Br J Surg. 1970 Apr;57(4):289–296. doi: 10.1002/bjs.1800570414. [DOI] [PubMed] [Google Scholar]
  18. Kilby J. O., Griffith C. A. The relationships of gastric transection and vagotomy to gastric emptying. Surgery. 1971 Apr;69(4):633–636. [PubMed] [Google Scholar]
  19. McKelvey S. T. Gastric incontinence and post-vagotomy diarrhoea. Br J Surg. 1970 Oct;57(10):741–747. doi: 10.1002/bjs.1800571012. [DOI] [PubMed] [Google Scholar]
  20. Shina E., Griffith C. A. Selective and total vagotomy without drainage: a comparative study of gastric secretion and motility in dogs. Ann Surg. 1969 Mar;169(3):326–333. doi: 10.1097/00000658-196903000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wilkinson A. R., Johnston D. Effect of truncal (T.V.), selective (S.V.), and highly selective vagotomy (H.S.V.) in man on gastric emptying of food and barium. Br J Surg. 1972 Apr;59(4):308–308. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES