Method of Testing for Complete Nerve Section During Vagotomy

Abstract

RESULTS OF VAGOTOMY AND GASTRO-ENTEROSTOMY MEDIC1LJRNAL 615 reduced to a figLure as low as, or lower than, the best after gastrectomy.We at one time thought that the incidence of changed bowel habit after vagal-nerve section might wveigh in favour of gastrectomy.However, a study of these symptoms after gastrectomy reveals exactly the same problem, although to a somewhat less degree.In trying to assess the place of vagotomy and gastro- enterostomy, we do not believe that it is indicated only in certain types of patient, as, for example, in women and elderly men.If it is to be used at all, then in our view it should be used in all cases where surgery is necessary.In the present state of our knowledge, based on this eight-year study, we believe that.given complete nerve-trunk section, vagotomy and gastro-enterostomy is the operation of choice.At one time we thought that a surgeon experienced in this operation could in every case achieve complete nerve-trunk section without the use of a test.Since such a test has been available we have satisfied ourselves that this is not true and that even an experienced surgeon will obtain better results with this help.It will be interesting, in the future, to study the late results of this operation in cases in which complete nerve-trunk section has been proved at operation.Summary 301 cases, of which only 6 are untraced, of duodenal ulceration treated by vagotomy and gastro-enterostomy are reported.All patients have been followed up for at least seven years.The proved recurrence rate was 4.25%, and this in spite of evidence of a high rate of incomplete nerve section.There has been no proved recurrence in this series since an earlier review in 1955.The results of this operation are compared with those of gastrectomy, and it is concluded that vagotomy and gastro-enterostomy is a better operation so long as there is no great increase in the recurrence rate as shown by a long-term study.From the point of view of nutritional state, anaemia, maintenance of weight and ability for heavy work, vagotomy and gastro-enterostomy is more satisfactory than gastrectomy.The only less favourable symptom after this operation is some looseness of the bowels, which takes on the picture of occasional loose motions.This same symptom, with the same pattern though in somewhat milder form, is found to occur also after gastrectomy.No patient in this series seems to have sought advice for this symptom.This high incidence of incomplete nerve section in the past is good evidence that this operation is better under- taken with the help of a test for complete nerve trunk section which can be used during operation.Such a test is now available (Burge and Vane, 1958).It is concluded that vagotomy.andgastro-enterostomy is the operation of choice in either sex and at any age when surgery is indicated for chronic duodenal ulceration.This investigation has been made possible by the financial help of the Dan Mason