The influence of the individual surgeon and of the type of vagotomy upon the insulin test after vagotomy.

Six hundred and seventy-six insulin tests performed in the early postoperative period after vagotomy and drainage for duodenal ulcer were analysed by the criteria of Hollander. Consultants had done 364 vagotomies, of which 17.6% were shown to be incomplete. Registrars and senior registrars had done 312, of which 12.2% were incomplete. Thus, consultants may not be significantly better, on average, than their juniors at achieving complete gastric vagotomy, even when allowance is made for the fact that they tend to take on the more difficult cases. The ability to achieve a complete vagotomy varied widely from surgeon to surgeon, regardless of his status. Of 515 truncal vagotomies, 15.7% were incomplete compared with 14.3% of 161 bilateral selective vagotomies. An ;early-positive' secretory response within one hour of the insulin injection, which is commonly regarded as indicating inadequate vagotomy, was found in 5.6% of patients after truncal vagotomy and 3.1% of patients after selective vagotomy.