PubMed1981
The success of selective proximal vagotomy in the treatment of chronic duodenal ulcer is dependent on complete denervation of the proximal part of the stomach, as well as on the preservation of antral innervation. Inadequate nerve dissection results in therapeutic failure. The most frequent cause of recurrent ulcers is incomplete vagal denervation of the acid-secreting cells. Therefore, it would seem desirable to use an intraoperative test to check completeness of vagotomy, giving the surgeon the possibility of rectifying an inadequate nerve section still at the time of operation. Among several methods the electrical stimulation test described by Burge and Vane has gained general acceptance. However, the question of whether the intraoperative test actually improves the results of vagotomy remains equivocal. In an initial series of 39 vagotomies we ensured completeness of denervation by the electrical stimulation test. In a subsequent series of 44 operations vagotomy was performed without the test. The patients were re-examined one and again two years following operation (clinical evaluation, gastroscopy and/or X-ray examination). The results of this retrospective analysis using the classification of Visick showed no difference between the two series. Hence, we have no reason to suppose that omission of the intraoperative test will result in an increased number of incomplete vagotomies, provided the surgeon has gained his experience in this operative procedure by using the test to check his surgical technique, which thereby becomes standardized. Thereafter, the Burge test becomes dispensible.