Proximal gastric vagotomy or truncal vagotomy and drainage for chronic duodenal ulcer?

A comparison has been made between truncal vagotomy and drainage (TVD) and proximal gastric vagotomy (PGV) performed electively for chronic duodenal ulceration from 1968 to 1981 in 209 and 272 patients respectively. The morbidity was 23 per cent after TVD and 19.8 per cent after PGV, with a mortality of 0.5 per cent and 0.4 per cent respectively. Of 163 patients in the former group and 253 patients in the latter group the follow-up was an average of 5.7 and 6.2 years respectively; 128 patients (78.5 per cent) and 198 (78.3 per cent) respectively had a good functional result, graded as Visick I and II, but 35 (21.7 per cent) and 55 (21.7 per cent), respectively, had a poor result owing to recurrent ulceration in 23 (14.1 per cent) after TVD and 44 (17.4 per cent) after PGV. These results were not statistically different. The frequency of diarrhoea was 23 per cent and dumping 6.8 per cent after TVD which was significantly reduced to 2.0 per cent (P less than 0.005) and 1.2 per cent (P less than 0.025), respectively, after PGV. However, only five patients (3.0 per cent) had severe symptoms from diarrhoea and two (1.2 per cent) from dumping after TVD. Both operations seem to carry an equal incidence of unsatisfactory results, though for slightly different reasons it might be concluded that both procedures have an equal degree of acceptability.