Highly selective vagotomy: a 14-year experience.

Since August 1971, 244 highly selective vagotomies were performed for pyloric and duodenal ulceration by one surgeon (W.A.F.M.). There was one postoperative death. Twenty (8 per cent) patients were lost to follow-up. The remaining 223 patients were followed up for 1 to 14 years (mean 4.2 years). On the modified Visick grading system 83.4 per cent were Visick I or II and 16.6 per cent were Visick III or IV. The failures were mainly recurrences. The recurrence rate was 11.2 per cent. Certain factors were examined to try to elucidate those influencing recurrence rate but no significant prognostic indicator was found. Acid studies were analysed and no significant relationship between these and the development of a recurrence could be found. The second 100 vagotomies were better than the first as judged by the results of studies of insulin-stimulated acid. Finally, we question whether all recurrences should automatically be regarded as treatment failures and the patients classified as Visick IV.