A comparative study on gastric emptying and secretory status in the early postoperative period after truncal vagotomy with two pyloroplasty variants performed for peptic ulcer disease. I. Cassimally pyloroplasty.
Gastric emptying (GE) of a radiolabeled solid meal, gastric acid secretion and gastrin release were examined within a median of 15.5 days (range: 9 to 66) after surgery in 14 peptic ulcer patients subjected to truncal vagotomy with Cassimally pyloroplasty (VTP-Cas). A significant delay in GE was observed after VTP-Cas; the median slope of GE curves, K, decreased from 14.65 (range: 2.56 to 21.86) before to 4.05 (range: 0 to 11.67) min-1.10-3 after the operation (p less than 0.002). The postoperative GE was significantly slower than in a group of 41 healthy controls (median K = 9.09, range: 3.72 to 28.66 min-1.10(-3), p less than 0.01 vs the VTP-Cas-operated patients), and was characterized by a biphasic pattern with a slowed second phase. VTP-Cas resulted in a reduction of the basal acid secretion by an average of 87% (from 9.5 +/- 3.4 to 1.2 +/- 0.2 mmol.h-1, p less than 0.05), and the pentagastrin-stimulated acid output by 72% (from 30.8 +/- 7.2 to 8.6 +/- 1.6 mmol.h-1, p less than 0.05). The fasting serum gastrin concentration remained unchanged after VTP-Cas (68.2 +/- 10.8 pre- vs 67.3 +/- 9.4 ng.1-1 post-operatively), whereas a slight and statistically insignificant increase in the meal-induced gastrin release was found following the VTP-Cas-AUC0-120: 10002 +/- 1298 pre- vs 11234 +/- 1422 ng.1-1 min postoperatively.