Truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer in India

Background. Insufficient information is available on long term results of truncal vagotomy and gastrojejunostomy since most previous series have relied on functional grading using the Visick scale which possibly both overdiagnoses and underdiagnoses complications. We used endoscopy to assess the results following truncal vagotomy and gastrojejunostomy as well as functional grading and compared them with published results of highly selective vagotomy. Methods. Two hundred patients were reviewed (5-11 years after truncal vagotomy and gastrojejunostomy) by clinical examination and endoscopy. Completeness of vagotomy was assessed by estimation of the postprandial alkaline tide in the urine and gall bladder using ultrasonography. Results. The ulcer recurrence rate was 15 (7%). Nine (60%) of the recurrent ulcers were asymptomatic and detected only on endoscopy. In all patients with recurrence, the urinary alkaline tide estimation revealed an incomplete vagotomy. Dumping was present in 12%, it was troublesome in 4%, occasional episodes of post-vagotomy diarrhoea in 6% (all in Visick grades I or II) and bile vomiting in 17% (affecting the lifestyle in only 5%). Recurrence and other complications were not related to the experience of the operating surgeon or the type of gastroenterostomy. There was no mortality. Overall, satisfactory long term functional results (Visick grades I and II) were found in 8% of patients. Conclusions. Truncal vagotomy and gastrojejunostomy still remains the best option in the surgical management of chronic duodenal ulcer. Long term results are good with a relatively low incidence of troublesome complications.