["Intraoperative controlled" or "enlarged" proximal gastric vagotomy, an excellent ulcer surgery, does it not have elective indications any more?].

Abstract

Proximal gastric vagotomy controlled by intraoperative testing, preferred for locating the zone of denervation (or "enlarged" to section of the gastroepiploic nerve, as these tests show), not only is the technique that has the lowest morbimortality but also a small number of recurrences, about 1%. In this study we prospectively and objectively evaluated (endoscopy, basal study, stimulated acid secretion and pH measurement) 88% of 777 vagotomies performed between 1971 and 1980 (10-17 years earlier) to demonstrate that the results are maintained and that after the fourth year the probability of recurrence is 2 per thousand. Acid secretion rises in a nonsignificant way, without reaching safety levels, during the first 5-9 years, remaining stabilized for at least 17 years except for duodenal recurrences that are due to incomplete denervation of the acid secretion zone, which continue to produce increased acid production. Out of 318 endoscopies, we only saw 3 "new gastric ulcers" in asymptomatic operated patients. As for the decline in the number of elective indications, this is more of less due to the occurrence of graver complications that must be urgently operated, and are accompanied by mortality. H2 or proton transport blockers heal the ulcer, but it remains to be demonstrated that after 10 years more than 95% will remain healed without grave complications, as occurs with surgery. The elective indication of efficient and safe surgery can be prophylactic against serious complications in the ulcer patient, which are responsible for mortality, a mortality that is not decreasing in the world population.