A prospective randomized trial of vagotomy in chronic duodenal ulceration

Koffman, C. G.; Elder, J. B.; Gillespie, Iain; Ganguli, P. C.; Ostick, D. G.; Cowley, David J.; Dymock, I. W.; Tweedle, D. E. F.; Schofield, Philip F.; Pengelly, C. D. R.; Shafiq, M. Najeeb; Shreeve, David R; Palmer, Melissa

doi:10.1002/bjs.1800660302

Cited by 17 publications

(3 citation statements)

References 15 publications

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“…This point may have a bearing on the induction of diarrhea, especially as these patients seemed to consume less fat [31]. Another important difference between patients subjected to total and subtotal gastrectomy is the extra gastric denervation in the former group, which has the potential to cause diarrhea in some patients [33,34]. The generally held view that subtotal gastrectomy has obvious clinical advantages can therefore be substantiated from the data in the present randomized controlled clinical trial.…”

Section: Discussionmentioning

confidence: 58%

Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures

et al. 1997

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The choice of reconstruction after gastrectomy and the significance of remaining reservoir function is a matter of controversy. To broaden the criteria for choice of treatment, we conducted a prospective randomized clinical trial to determine the impact of various gastrectomy procedures on quality of life. Consecutive patients (n = 64) eligible for curative gastric cancer surgery were randomized to have either a total (n = 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) implanted as a gastric substitute. The quality-of-life evaluation was based on a battery of questionnaires covering both general and specific aspects of life. The patients were rated by one of two psychiatrists who were blinded to the patients' group affiliation. Assessments were made on three occasions: during the week prior to surgery and 3 and 12 months after the surgical intervention. The postoperative complication and mortality rates were similar in all treatment groups, with few serious complications recorded. Irrespective of type of treatment, the patients suffered from alimentary symptoms and functional limitations in everyday life, whereas their mental well-being improved after surgery. Patients who underwent subtotal gastrectomy had the best outcome, especially with respect to complaints of diarrhea. Patients given a gastric substitute after gastrectomy showed no difference from those who had only a total gastrectomy. We conclude that despite significant unfavorable consequences that follow gastrectomy, patients recover with an improved mental status. A pouch reconstruction after total gastrectomy does not improve quality of life, but a subtotal gastrectomy has advantages that must be considered when the procedure is clinically feasible.

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Section: Discussionmentioning

confidence: 58%

Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures

et al. 1997

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“…T h e technique of highly selective vagotomy makes an important but unproven assumption that the parietal cells are indeed confined to the region of the corpus of the stomach and do not extend beyond the macroscopic antrum-corpus boundary. However, a high rate of recurrent ulceration has been reported (Kronborg and Madsen, 1975;Koffman et al, 1983;Adami et al, 1984;Hoffmann et al, 1984), probably caused by inadequate denervation of the parietal cell mass, either along the esophagus or in the region of the antrum-corpus boundary.…”

Section: Introductionmentioning

confidence: 99%

Distribution of the vagus nerve to the human pyloric antrum and possible surgical implications

et al. 1990

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"Highly selective" or "proximal gastric" vagotomy seeks to denervate the parietal cell mass of the stomach while preserving the innervation of the pyloric antrum, and is now frequently used in the surgical treatment of duodenal ulceration. However, a high incidence of recurrent ulceration after highly selective vagotomy has been reported, suggesting inadequate denervation of the parietal cell mass. This study aims to examine the innervation of the distal parietal cell mass by antral nerves and their possible role in recurrent ulceration after highly selective vagotomy.The distribution of the nerves supplying the pyloric antrum, distal to the termination of the nerve of Latarjet, was compared to the parietal cell boundary in 20 stomachs.Parietal cells extended all the way to the distal pylorus in 35% of stomachs and could potentially have been innervated by antral branches in 55%. Branches from the anterior vagal trunk terminated on the posterior antral surface in 25% of stomachs and from the posterior trunk on the anterior surface in 20%.These findings suggest that there may be an anatomical limitation to complete denervation of the distal parietal cell mass during a standard highly selective vagotomy where the nerve of Latarjet and all the branches distal to it are spared.

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“…(Arch Surg 115: [33][34][35][36][37][38][39]1980) The objective of highly selective gastric vagotomy (HSV) is the complete denervation of the gastric parietal cell mass without damage to the vagai nerve supply of the stomach antrum and pylorus. The denerva¬ tion is brought about by transecting the entire neurovascular inflow to the lesser curvature from the boundary level, working proximally close to it.…”

mentioning

confidence: 99%

Highly Selective Transgastric Vagotomy

Petropoulos¹

1980

Arch Surg

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A prospective randomized trial of vagotomy in chronic duodenal ulceration

Cited by 17 publications

References 15 publications

Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures

Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures

Distribution of the vagus nerve to the human pyloric antrum and possible surgical implications

Highly Selective Transgastric Vagotomy

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