[Vagotomy of the oxyntic cells associated with simple closing as surgical treatment of perforated duodenal ulcer. A comparative study with simple closing alone].

Abstract

To evaluate the incidence of ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective and randomized study in patients with perforated duodenal peptic ulcer, within 10 hours after the acute episode and without intercurrent serious diseases. In a total of 180 patients, oxyntic cell vagotomy (VCO) with simple closure or simple closure alone were performed alternatively in the period from 1971 to 1977. Periodic controls were established that included clinical, radiographic and gastroduodenoscopic evaluation. Twelve years after operation, 115 of the patients could be evaluated. Recurrence was defined as endoscopic or surgical evidence of the ulcerous lesion. The endoscopic results after 12 years showed 1.56% of relapses in the group that underwent oxyntic cell vagotomy with simple closure, and 54.9% in the group that only had simple closure (p less than 0.0005). There were also significant differences in the clinical and radiographic controls, and in the degree of comfort achieved with the technique. Mortality was null in both groups and there were no differences between the two techniques as regards morbidity. The results obtained in this study show that oxyntic cell vagotomy with simple closure of the perforation may be the technique of choice in the treatment of perforated duodenal peptic ulcer, which is why we think is should be more extensively used in emergency services.