Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer

• Published in: World journal of surgery 1991-03, Vol.15 (2), p.286-291
• Main Authors: Wang, Chia‐Siu, Tzen, Kai‐Yuan, Huang, Miau‐Ju, Chen, Pang‐Chi, Chen, Miin‐Fu
• Format: Article
• Language: English
• Subjects: Adult; Cual; Dilatation; DTPA; Duodenal Obstruction - physiopathology; Duodenal Obstruction - surgery; Duodenal Ulcer; Duodenal Ulcer - physiopathology; Duodenal Ulcer - surgery; Duodenal Ulcer Patient; Female; Gastric Emptying - physiology; Humans; Male; Mese; Middle Aged; Postoperative Period; Preoperative Care; Pyloric Stenosis - physiopathology; Pyloric Stenosis - surgery; Time Factors; Vagotomy, Proximal Gastric
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01659066

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium‐diethylene penta‐acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year. Résumé La vidange gastrique a été étudiée chez des patients ayant un ulcère duodénal avec ou sans sténose, avant l'intervention, à une semaine, à 3 mois et à un an après une vagotomie suprasélective (VSS). Le repas test comportait 1 mCi de 99m Technétium‐diéthylène/acide panta‐acétique (DTPA) dilué dans 500 ml de sérum physiologique isotonique. Les patients étaient divisés en 2 groupes: groupe 1 (n=16) sans sténose clinique, qui ont eu seulement une VSS servant de contrôle; groupe 2 (n =14) avec sténose de légère à modérée, ayant eu une VSS et une dilatation transgastrique pour obtenir un canal pylorique de 20 mm de diamètre. Avant la VSS, le groupe à sténose présentait un temps de vidange significativement plus lent que le groupe sans sténose. La plupart des patients du groupe à sténose ont repris une alimentation normale rapidement après l'intervention mais ils ont conservé un temps de vidange plus lent. Au bout de 3 mois, la courbe de vidange chez les