title: Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer.
abstract: Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium-diethylene penta-acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.
authors.affiliation: Department of Surgery, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
authors.forename: C S
authors.initials: CS
authors.lastname: Wang
authors.forename: K Y
authors.initials: KY
authors.lastname: Tzen
authors.forename: M J
authors.initials: MJ
authors.lastname: Huang
authors.forename: P C
authors.initials: PC
authors.lastname: Chen
authors.forename: M F
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000328:Adult; D004106:Dilatation; D004380:Duodenal Obstruction / Q000503:physiopathology / Q000601:surgery*; D004381:Duodenal Ulcer / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011707:Pyloric Stenosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014629:Vagotomy, Proximal Gastric