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Anterior gastric stapling with posterior truncal vagotomy was examined as an alternative to highly selective vagotomy in the treatment of peptic ulcer disease. A clinical series of 32 patients who underwent the combined procedure is presented; gastric acid output was adequately reduced (basal output by 82 per cent, peak by 64 per cent). Motility changes were temporary and mild. Clinical follow-up, using a modified Visick grading, showed good to excellent results in 21 of 25 patients who could be classified. This procedure is suggested as an appropriate alternative to highly selective vagotomy.

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

In a group of clinical patients with duodenal ulcer submitted to highly selective vagotomy, gastric emptying studies were performed pre-operatively and 2 weeks and 6 months after surgery. A standard liquid meal labeled with radioactive technetium was used for scanning. In this group of duodenal ulcer patients, no abnormal emptying was noted prior to surgery as compared with controls. After highly selective vagotomy, the gastric emptying time for liquids was statistically shorter as compared with preoperative values. It is concluded that highly selective vagotomy may be the operative treatment of choice for duodenal ulcer patients with respect to acid secretion, but that it alters gastric motility and emptying significantly.