Postvagotomy and Cholecystectomy Syndrome

Seventy-five patients with unsatisfactory results following vagotomy, drainage and cholecystectomy have been reviewed. The operations were performed together in 45 patients, vagotomy preceded cholecystectomy in 16 patients and cholecystectomy was performed before vagotomy in 14 patients. The interval between the two operations when cholecystectomy was performed first was 7.1 +/- 1.66 SE years, whereas when vagotomy was performed first this was 3.1 +/- 1.03 SE years (p less than 0.05). Forty-three patients had symptomatic bile reflux gastritis and 59 had postvagotomy diarrhea. Dumping, bilious vomiting and recurrent peptic ulceration occurred in 11 patients, nine and five patients, respectively, and were no more frequently encountered than would have been expected after vagotomy and drainage alone. In the light of the information derived from the addition of cholecystectomy to vagotomy and drainage a pathophysiology of postvagotomy diarrhea without dumping, and bile reflux gastritis without bilious vomiting or recurrent chronic peptic ulceration is postulated.