Therapeutic applications of vagotomy.

The treatment of the peptic ulcer disease involves several options. The present discussion deals with the long-term management with emphasis on the application of vagotomy. Eradication of Helicobacter pylori is the treatment of choice in ordinary peptic ulcer patients. Exceptions are non-steroidal, anti-inflammatory drug-induced ulcers and the Zollinger-Ellison syndrome. Failures to eradicate H. pylori in old or unfit duodenal ulcer patients and most gastric ulcer patients will lead to intermittent antisecretory treatment or continuous maintenance treatment. Maintenance treatment will usually mean lifelong treatment, and optimal results are probably obtained with a full-dose antisecretory regime. Failures to eradicate H. pylori in young and fit duodenal ulcer patients is the group of patients to whom proximal gastric vagotomy can still be recommended as an elective surgical procedure. The proximal gastric vagotomy should preferably be performed with the laparoscopic technique. Evidence is presented that completeness of vagotomy is of clinical importance. The completeness of vagotomy can be tested and defined.