A seven year experience with more than 800 vagotomies for peptic ulcer at the Veterans Administration Hospital, Long Beach, Calif., has shown that success with this procedure depends on the following factors: (1) proper selection of cases,1 (2) skill and experience of the surgeon in achieving a complete vagotomy, (3) incorporation of an adequate pyloroplasty,2 and (4) careful and prolonged postoperative management of the patient until gastrointestinal function is readjusted.
An adequate vagotomy that results in the healing of an ulcer creates certain alterations in the autonomic nervous control of the gastrointestinal tract. These changes are variable from patient to patient. In the vast majority of patients they are minimal and transient. In some, however, they are severe and prolonged. In this latter group, if proper attention is paid to the early symptoms and follow-up x-ray studies, methods of management can be used that lead to the restoration