Vagotomy
| Vagotomy | |
|---|---|
| Intervention | |
 Course and distribution of the glossopharyngeal, vagus, and accessory nerves. |
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| ICD-9-CM | 44.0 |
| MeSH | D014628 |
A vagotomy is a surgical procedure that involves resection of the vagus nerve.
See Types below for types/variations of vagotomy.
Contents |
Applications [edit]
Truncal vagotomy is a treatment option for chronic duodenal ulcers.[1][2] It was once considered the gold standard but is now usually reserved for patients who have failed the first-line "triple therapy" against Helicobacter pylori infection: two antibiotics (clarithromycin and amoxicillin or metronidazole) and a proton pump inhibitor (e.g., omeprazole). It is also used in the treatment of gastric outlet obstruction.[3][4]
The use of vagotomy to treat obesity is being studied.[5] Early results show an average of 18% weight loss.[6] Vagotomy may have an impact upon ghrelin.[7]
History [edit]
Vagotomy was once popular as a way of treating and preventing peptic ulcer disease[8] and subsequent ulcer perforations.[9][10] It was thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the parietal cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of gastroesophageal reflux in those who suffered from it. The incidence of vagotomy decreased following the discovery by Barry Marshall and Robin Warren that H. pylori is responsible for most peptic ulcers, because H. pylori can be treated much less invasively. One potential side effect of vagotomy is a vitamin B12 deficiency. As vagotomy decreases gastric secretion, intrinsic factor production can be impaired. Intrinsic factor is needed to absorb vitamin B12 efficiently from food, and injections or large oral doses of the vitamin may be required after such a procedure in certain populations.[11]
Types [edit]
A plain vagotomy eliminates the parasympathetic supply from the stomach to the left side of the transverse colon.
Other techniques focus on branches leading from the retroperitoneum to the stomach.[12]
Highly selective vagotomy refers to denervation of only those branches supplying the lower esophagus and stomach (leaving the nerve of Latarjet in place in order to ensure the emptying function of the stomach remains intact). It is one of the treatments of peptic ulcer.
References [edit]
- ^ Kuremu RT (2002 Sep). "Surgical management of peptic ulcer disease". East African Medical Journal 79 (9): 454–6. PMID 12625684.
- ^ Chang TM; Chan DC; Liu YC; Tsou SS; Chen TH (2001 Apr). "Long-term results of duodenectomy with highly selective vagotomy in the treatment of complicated duodenal ulcers". American Journal of Surgery 181 (4): 372–6. doi:10.1016/S0002-9610(01)00580-3. PMID 11438277.
- ^ Siu WT; Tang CN; Law BK; Chau CH; Yau KK; Yang GP; Li MK (2004 Oct). "Vagotomy and gastrojejunostomy for benign gastric outlet obstruction". Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A 14 (5): 266–9.
- ^ Wyman A; Stuart RC; Ng EK; Chung SC; Li AK (1996 Jun). "Laparoscopic truncal vagotomy and gastroenterostomy for pyloric stenosis". American Journal of Surgery 171 (6): 600–3. doi:10.1016/S0002-9610(95)00030-5. PMID 8678208.
- ^ "Could nerve-snipping spur weight loss? - USATODAY.com". USA Today. 2007-07-02. Retrieved 2010-05-27.
- ^ Research into 20 minute nerve cutting procedure results in average 18% weight loss
- ^ Williams DL, Grill HJ, Cummings DE, Kaplan JM (December 2003). "Vagotomy dissociates short- and long-term controls of circulating ghrelin". Endocrinology 144 (12): 5184–7. doi:10.1210/en.2003-1059. PMID 14525914.
- ^ Lygidakis NJ (1984 Mar). "Posterior truncal vagotomy and anterior curve superficial seromyotomy as an alternative for the surgical management of chronic ulcer of the duodenum". Surgery, Gynecology & Obstetrics 158 (3): 251–4.
- ^ Boey J; Lee NW; Koo J; Lam PH; Wong J; Ong GB (1982 Sep). "Immediate definitive surgery for perforated duodenal ulcers: a prospective controlled trial". Annals of Surgery 196 (3): 338–44. doi:10.1097/00000658-198209000-00013. PMC 1352612. PMID 7114938.
- ^ Boey J; Branicki FJ; Alagaratnam TT; Fok PJ; Choi S; Poon A; Wong J (1988 Aug). "Proximal gastric vagotomy. The preferred operation for perforations in acute duodenal ulcer". Source:Annals of Surgery 208 (2): 169–74.
- ^ http://www.pernicious-anaemia-society.org
- ^ Jordan PH, Thornby J (September 1994). "Twenty years after parietal cell vagotomy or selective vagotomy antrectomy for treatment of duodenal ulcer. Final report". Ann. Surg. 220 (3): 283–93; discussion 293–6. doi:10.1097/00000658-199409000-00005. PMC 1234380. PMID 8092897.
External links [edit]
- Vagotomy at the US National Library of Medicine Medical Subject Headings (MeSH)
- 00934 at CHORUS
- -939130865 at GPnotebook
- Overview and illustrations at surgeryencyclopedia.com
- Four types, at endoscopy-sages.com
- Overview at healthatoz.com
- News article — interview
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