Possible physiological advantages of parietal cell vagotomy.

Parietal cell vagotomy (PCV) without drainage is associated with the lowest mortality of any operation currently being widely used for the elective treatment of duodenal ulcer. There are fewer gastrointestinal complaints of the type observed after more orthodox gastric operations. Diarrhea and dumping may occur after PCV in approximately 5 percent of patients, and when these complaints do occur they are milder and more easily controlled than after other types of operation. This improvement is attributed to retention of the peristaltic action of the antrum and an intact pyloric sphincter, which together, permit gastric emptying that is more normal than that which occurs with any other gastric procedure. There is insufficient evidence to indicate that retention of antral innervation exerts an inhibitory or a stimulatory effect on acid secretion which would be either beneficial or detrimental to the duodenal ulcer patients. The acid secretory rates are reduced effectively by PCV and equal the reductions that follow truncal vagotomy and drainage. Acid secretory rates increase during the first postoperative year and then remain rather constant with time. This observation and the reports that the rate of recurrent ulcers after 2 to 4 years follow-up is two to four percent, suggests that PCV is a highly effective procedure.