Volume : 2, Issue : 4, April - 2013

Short Term Review of Highly Selective Vagotomy for Emergency Management of Selective Cases of Perforated Duodenal Ulcer, Evaluation of 30 Cases At a Peripheral Indian Hospital

Dr Mandar Tilak , Dr Ashutosh Mishra, Dr Kamlesh Verma, Dr Manish Kumar Agrawal

Abstract :

Perforated duodenal ulcer is a common cause of patient presenting with acute abdominal pain to the emergency ward. In such patients after careful screening, highly selective vagotomy in the same sitting as primary closure of the perforation can provide durable reduction in acid secretion and decrease the further complications of hyperacidity without any additional cost to the patient. The aim of the study was to examine feasibility & efficacy of highly selective vagotomy in emergency management of selective cases of perforated duodenal ulcer.  Patients & methods:1: Patients of perforation peritonitis with intra –operative diagnosis of duodenal perforation were evaluated.2: Exclusion criteria: Age < 31 years and > 70 years, poor general condition, large duodenal ulcer with (> 2*2 cm), duration of symptom more than 24 hrs, history of prolonged N.S.A.I.D intake & other perforation sites. A cohort of 60 patients were selected and randomly divided into test and control. In test group, primary closure of perforation along with live omental patching with highly selective vagotomy was done. In control group, perforated duodenal ulcer was managed by primary closure with live omental patch. Post operatively patients were observed for pain, fullness and abdominal distension. 24 hours Ryle’s tube aspirate was measured on day 1 and day 5 post op for quantity (ml) & pH. Patients were reviewed after 6 months and 1 year for complaints if any & presence of acid secreting gastric mucosa with Congo red dye. Symptomatic relief analysis was done by using Visick score. 11 After 1 year, in test group 83.33% patients showed Grade 1 Visick score whereas 26.66% in control. Average range of pH was 5–6 for test group and 2–3 for control (p<.0001). Conclusions: Highly selective vagotomy done in the same sitting with primary repair of duodenal ulcer in emergency gives durable acid suppression and can prevent prolonged pain and complications of chronic hyperacidity with minimal additional morbidity and without any additional cost.