[Supraselective or proximal gastric vagotomy. Report of 1,250 surgical cases. 777 special cases with objective follow-up for over 10 years].

From August, 1970 to February, 1989, we performed 1,105 elective and 145 emergency PGVs (proximal gastric vagotomy). The emergent cases included 118 perforations and 27 bleeding lesions. Since September, 1973, we have been able to measure the pH of the mucosa using a GR282C transesophageal electrode. Two cases of exitus (0.2%) were noted. With an intraoperative test (pH) or the systematic section of the gastroepiploic nerve (n.ge) (randomized with 269 cases followed up over 57 months) the rate of recurrence does not exceed 2%. Without these "tools", it is as high as 10%. Since this rate is still a cause of confusion in this 20th year of PGV, we analyse 684 "stabilized" (excluding the first 10 patients of each surgeon). PGVs followed up (88% of 777 PGVs) over 10 to 17 years. The study was clinical and radiological in 100% of cases, based on acid secretion in 2/3, and fiberscopic in 47%. Between 5 and 17 years, 318 patients had a fiberscopic study and 325 an analysis of the basal and stimulated acid secretion (76% were already evaluated preoperatively). Two types of recurrence were defined: those due to failure of the surgeon or technique (gastroepiploic nerve in 1/5 of cases) involving acidity--this being the "persistent" ulcer (3/4 of cases during the first years); and disorders in gastric evacuation (?) with a very low acidity level, also causing more delayed gastric ulcers. The non-cumulative probability of R in successive years stays around 0.2 to 0.1% after the 3rd or 4th year following the PGV, and the total rate after 10 years or more is about 10%. If performed by experienced surgeons and with the intraoperative test (or systematic section of the n.ge), PGV should have only a low rate of failure, these cases being more amenable to treatment than an anastomotic mouth ulcer following resection, for instance.