What are the relative indications and contraindications to highly selective vagotomy?
- Highly selective vagotomy is indicated for the treatment of intractable duodenal ulcers because, unlike truncal vagotomy, it does not require a drainage procedure, because antral peristalsis and sphincter function are preserved.
- It has also been used in the emergent treatment of bleeding or perforated duodenal ulcers in stable patients.
- It reduces the basal and stimulated acid secretion by more than 75% and 50% respectively. Highly selective vagotomy is contraindicated in patients with prepyloric ulcers or with GOO because they demonstrate high rates of recurrent ulceration.
- The ulcer recurrence rate is closely tied to the surgeon’s experience with this operation and in the PPI era should only be performed by an experienced GI surgeon well versed in the technique.
- Because of its high recurrence rate, and the fact that most surgeons have very little experience with this procedure, it is rarely used today.
