Summary
This study reports the long-term results of 216 patients after highly selective vagotomy (HSV) for duodenal ulcers operated from 1970 through 1978 with a mean follow-up of 12.8 years (8.3–15). 26 patients developed symptomatic ulcer recurrences (12%) within 4 to 135 months following surgery, the cumulative recurrence rate (Kaplan-Meier) at 13 years was 20.3%. Acidity analyses showed a postoperative mean reduction of basal acid output (BAO) and maximal acid output (MAO) values of 80.7 % and 74.8 % respectively with no differences according to recurrences. The risk of recurrence was similar for duodenal (22/194) and pyloric ulcers (4/22) and no differences were found with respect to sex, additional drainage procedure, smoking habits, acute or elective operation and first or recurrent ulcers. Risk was slightly higher for complicated ulcers (p ≤ 0.07), but without reaching statistical significance. 78.5% of patients showed (very) good results (Visick I or II), only 6% were Visick III. HSV is therefore regarded as a valuable therapeutic measure for the treatment of duodenal ulcer independent of patient compliance.
Zusammenfassung
Es wird über die Langzeitergebnisse von 216 Patienten berichtet, bei denen zwischen 1970 und 1978 wegen eines Ulcus duodeni eine selektiv proximale Vagotomie (SPV) vorgenommen wurde. Die mittlere Nachbeobachtungszeit beträgt 12,8 Jahre (8,3–15). 26 Patienten erlitten ein symptomatisches Ulkusrezidiv (12%)4–135 Monate postoperativ, die kumulative Rezidivrate beträgt 20,3 % nach 13 Jahren (Kaplan-Meier). Säuresekretionsmessungen ergaben eine mittlere Reduktion der basalen (BAO) und mittleren stimulierten Sekretionswerte (MAO) von 80,7 bzw. 74,8 % ohne Unterschiede zwischen Patienten mit und ohne Rezidiv. Das Rezidivrisiko war für Ulcus duodeni (22 von 194) und pylorische Geschwüre (4 von 22) vergleichbar, ebenso fanden sich keine Unterschiede bezüglich dem Geschlecht, einer zusätzlichen Drainage-Operation, dem Rauchverhalten, akuter oder elektiver Operation und erstem oder Rezidivgeschwür. Nach der Operation komplizierter Ulzera war das Rezidivrisiko tendentiell höher (p ≤ 0,07). 78,5% der Patienten erreichten ein (sehr) gutes funktionelles Langzeitergebnis (Visick I oder II), nur 6% mußten als Visick III eingestuft werden. Die SPV kann daher als ein ungeachtet der Patienten-Compliance wirksames und wertvolles Therapieverfahren zur Behandlung des Ulcus duodeni erachtet werden.
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Literatur
Andersen D, Amdrup E, Höstrup H, Hanberg Sörensen F (1982) The Aarhus county vagotomy trial: trends in the problem of recurrent ulcer after parietal cell vagotomy and selective vagotomy with drainage. World J Surg 6:86–92
Balint JA, Spence MP (1989) Pyloric stenosis. Br Med J 1:890–894
Baron J, Alexander-Williams J, Allgöwer M, Muller C, Spencer J (1982) Vagotomy in modern surgical practice. Butterworths, London, pp 1976–1986
Breslow N (1970) A generalised Kruskal-Wallis test for comparing K-samples subject to unequal patterns of censorship. Biometrika 57:579–582
Caldwell JR, Cobbs S, Darling MD, Jough D de (1970) The dropout problem in antihypertensive treatment. J Chronic Dis 22:579–592
Clason AE, Macleod DAD, Elton RA (1986) Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage. Br J Surg 73:985–987
Goligher JC (1974) A technique for highly selective (parietal cell or proximal gastric) vagotomy for duodenal ulcer. Br J Surg 61:337–345
Goodman AJ, Kerrigan DD, Johnson AG (1987) Effect of the pre-operative response to H2-receptor antagonists on the outcome of highly selective vagotomy for duodenal ulcer. Br J Surg 74:897–899
Gray GR, Smith IS, McWinnie D, Gillespie G (1982) Five-year study of cimetidine or surgery for severe duodenal ulcer dyspepsia. Lancet 1:787–788
Hoffman J, Olesen A, Jensen H-E (1987) Prospective 14–18 year follow-up study after parietal cell vagotomy Br J Surg 74:156–159
Johnston GW, Spencer EFA, Wilkinson AJ, Kennedy TL (1990) Proximal gastric vagotomy: ten to twenty years follow-up (abstract FP 602). World congress of gastroenterology, Sydney, Australia
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
MacIntyre IMC, Millar A, Smith AN, Small WP (1990) Highly selective vagotomy 5–15 years on. Br J Surg 77:65–69
Mantel N (1965) Evaluation of survival data and two new rank order statistic arising in its consideration. Cancer Chemother Rep 50:163–165
Moody FG, Cornell GN, Beal JM (1962) Pyloric destruction complicating peptic ulcer. Arch Surg 84:462–465
Primrose JN, Axon ATR, Johnston D (1986) Highly selective vagotomy (HSV) and duodenal ulcers resistant to H2-blockers. Gut 27:A1282–1283
Schiessel R, Herbst F, Berlakovich G, Schemper M, Fritsch A (1990) Noteingriffe bei gastroduodenalem Ulcus. Chirurg 61:16–21
Stael von Holstein C, Graffner H, Oscarson J (1990) One hundred patients ten years after parietal cell vagotomy. Br J Surg 74:101–103
Stolte JB (1944) Gross bleeding from the digestive tract. The frequency of manifest bleeding in peptic ulcer with regard to the duration of the disease and to the age of the diseased. Acta Med Scand 116:584–593
Welch CE, Rodgkey GV, Gryska PV (1985) A thousand operations for ulcer disease. Ann Surg 204:454–467
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Herbst, F., Gruber, E., Pratschner, T. et al. Ergebnisse der selektiv proximalen vagotomie nach 13 Jahren. Langenbecks Arch Chir 377, 262–266 (1992). https://doi.org/10.1007/BF00189470
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DOI: https://doi.org/10.1007/BF00189470