The prognostic significance of radiologically determined gastric emptying time before proximal gastric vagotomy.
The importance of undisturbed pyloric function is known among surgeons applying proximal gastric vagotomy (PGV) for duodenal ulcer disease. On the other hand, the prognostic significance of subclinically impaired antroduodenal motility is unknown after this operation. Therefore, in the present study 43 PGV patients with normal gastric emptying were compared with 24 PGV patients with prolonged gastric emptying as to the postoperative incidence of ulcer recurrence and symptomatology. Prior to surgery gastric emptying time was determined radiologically in all patients, none of whom had symptoms or signs of gastric outlet obstruction. The duration of postoperative follow-up in the series was 8 to 11 years. The incidence of ulcer recurrence during follow-up was 16% in the whole series, being significantly higher among patients with the primary ulcer in the pyloric or prepyloric area than among those with the lesion in the duodenal bulb. Furthermore, in the patient group with a primary ulcer in the duodenum an excellent operation result was achieved significantly more frequently in the case of preoperatively normal gastric emptying than in the case of delayed emptying. The incidence of ulcer recurrence tended also to be higher among the duodenal ulcer patients with prolonged emptying than among those with normal emptying through the difference between the groups did not reach statistical significance. This study emphasizes the prognostic significance of unimpaired gastric emptying and of even minor subclinical motor dysfunction when electing PGV as the surgical treatment and also that radiologic determination of gastric emptying time before PGV is of value in all patients undergoing the operation, irrespective of the location of the primary ulcer.
D000328:Adult; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D011859:Radiography; D012008:Recurrence; D014629:Vagotomy, Proximal Gastric