Objective To investigate the effects of highly selective vagotomy plus mucosal antrectomy (HSVMA) and highly selective vagotomy (HSV) alone on the functions of the gastric antrum. MethodsEighteen dogs and 48 patients with chronic duodenal ulcer were tested. The time of gastric emptying, antral myoelectric activity, antral pressure were measured 4-6 months after operation in 18 dogs which were randomized into the control, HSV and HSVMA groups. The gastric evacuation, frequency and amplitude of electrogastrography (EGG) were observed 4-6 months after operation in 48 patients who were randomly divided into HSV (20 patients) and HSVMA (28 patients) group, their preoperative values were considered as control group. ResultsIt was found by barium meal examinations that the shape of the stomach and duodenum was normal and gastric peristalsis was clearly visible in all the animals and patients of two postoperative groups. The beginning and ending time of gastric emptying were (5.0±0.06) min and (4.0±0.4) h respectively in the dogs of HSVMA group, which were similar to those of the dogs of control and HSV group (Pgt;0.05). The frequency of the antral myoelectric action potential was (3.11±0.65 ) cycles/min in the dogs of HSVMA group, the frequency of EGG was (3.25±0.75) cycles/min in the patients of HSVMA group, which were significantly lower than that of the dogs or patients of control and HSV group (P＜0.05). Injection of pentagastrin in dogs or taking meal in patients significantly increased the antral pressure or amplitude of EGG. Conclusion The motor function of the reconstructed antrum in the HSVMA group approaches the normal level despite a lower antral myoelectric frequency. It is believed that HSVMA will be a choice for the treatment of duodenal ulcer.
To observe the changes of antral motor function and electrogastrography of 12 dogs and 30 patients with duodenal ulcer after highly selective vagotomy and mucosal antrectomy.Results: in an empty stomach, the preoperative and postoperative antral pressure value of dogs was similar, but the antral action potential frequency of dogs was slower after operation than that before operation. After injection of pentagastrin, whether before or after operation, the antral pressure value and action potential frequency of dogs were similar in the two groups. In an empty stomach, the electrogastrography frequency of patietns with duodenal ulcer was decreased after operation than that before operation, but their value of electrogastrography was similar, and after taking food, their preoperative and postoperative value and frequency of electrogastrography were significantly higher than that before taking food. But, whether before or after operation, there wasn’t significant diffence in them.Conclusions: there wasn’t changes of antral motor function and electrogastrography in dogs and patients with duodenal ulcer after highly selective vagotomy and mucosal antrectomy.
Modified Goligher’s highly selective vagotomy (HSV) for 217 cases of duodenal ulcers is reported. In this series they were: duodenal ulcer (100 cases), combined gastric and duodenal ulcers (79 cases) and complicated perforating, bleeding or stenosed ulcers (38 cases). In the complicated duodenal ulcer, HSV was usually carried out with suturing bleeding point, perforated ulcer or with pyloroplasty. With a follow-up of 3~20 years, the recurrence rate werelt;2% and 85.7% of cases had excellent or good results as Visick classification. Considerations relevant to the HSV technic are deemed worthy of emphasis; complete resection of gastric branches of anterior and posterior vagal trunks and preservation of the first limb of the "Crow’s foot", extended dissection of the distal 5-7cm of the esophagus and division of the distal 8-10cm of the bundle of the gastroepiploic vessels in order to deprive the whole parietal cell mass of its vagal supply. In 4 patients, recurrence were easily controlled with remedies or operation for gastric retention by rational type. The authors suggest that the modified HSV plus mucusdeprived antrectomy be the rational surgical choice for duodenal ulcer.
Objective To explore the effect of laparoscopic highly selective vagotomy (Hill) on the treatment for acute perforating duodenal ulcer. Methods In 19 patients with acute perforating duodenal ulcers, laparoscopic repair of the perforation, laparoscopic freeing of the vagus, cutting off of posterior vagal trunk, and highly selective resection of anterior vagal trunk were performed. Results In all 19 cases the operation was successful. No patient was converted into open highly selective vagotomy. Ulcer symptoms of 17 patients disappeared after operation, and gastroscopy in follow up after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 2 patients were markedly relieved and were easily controlled by medication. Conclusion The treatment of acute perforating duodenal ulcer by laparoscopic highly selective vagotomy (Hill) has the advantages of minor trauma, rapid postoperative recovery, and good results, it is a good procedure for the treatment of perforating duodenal ulcer.