Truncal Vagotomy for Peptic Pyloric Stenosis and Assessment of Completeness by Acid Tests

Abstract

Background: Several types of operations are used for Peptic pyloric stenosis (PPS) which includes Vagotomy with antrectomy or drainage procedures. This study was done primarily to analyze the completeness of Truncal vagotomy (TV) by gastric acid secretion tests. The secondary analyses included demographic, clinical profile and out come of the operation.

Methods: From December 27/2004 to June 26/2006, 32 consecutive patients, aged 10 to 65 years underwent trans-abdominal (TV) and Posterior Gastrojejunostomy for PPS at Glen C. Olsen memorial hospital. TV without mobilizing and encircling the esophagus. Prospective longitudinal case serial analysis was done to assess the completeness of TV. Outcome measures used for assessment were the pre-operative basal acid output (BAO), Post-operative BAO, Postoperative sham feeding acid out put (SAO) and other relevant clinical characteristics.

Results: After surgery, the average pre-operative BAO had decreased from 6.07+/- 2.7mmol/hour to 0.42+/-0.29mmol/hour. The BAO was decreased by 91.3%. Mean peak acid response after TV to SAO was 0.83+/- 0.45mmol/hour. The difference between the peak 15minutes out put of SAO and lowest 15 minutes out put of post-operative BAO did not exceed 0.6mmol in 30/32 patients. This shows that TV was complete in 93.7%. There was no operative mortality and clinically significant post-operative complication developed in only three patients.

Conclusion: Trans-abdominal TV done without mobilizing and encircling the esophagus was found safe and effective means of reducing acid secretion for patients with long standing peptic pyloric stenosis.