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November 5, 1982

Recurrence after duodenal ulcer surgery

JAMA. 1982;248(17):2097. doi:10.1001/jama.1982.03330170013004

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The ulcer recurrence rate associated with the more conservative of two surgical procedures for chronic duodenal ulcers—highly selective vagotomy (HSV)— may be higher than that for the more radical procedure—truncal vagotomy and pyloroplasty (TVP).

TVP was the most commonly performed surgery for chronic duodenal ulceration in Britain when a comparison trial began there in the early 1970s (Br J Surg 1979;66:145-148). The procedure eliminates gastric acid hypersecretion by interrupting the triggering parasympathetic nerve network to the stomach, liver, gallbladder, bile ducts, pancreas, small intestine, and part of the large intestine. The pyloroplasty relieves gastric stasis.

HSV involves selective dissection of the nerves to the fundus and body of the stomach, while preserving as many as possible of the vagal nerves to the antrum and pylorus. One investigator, James C. Thompson, MD, of the University of Texas Medical Branch, Galveston, recently noted that this operation "is associated with a rate of