Parietal Cell Vagotomy versus Vagotomy‐antrectomy: Ulcer Surgery in the Modern Era

Abstract

Abstract. Patients with peptic ulcer occasionally develop complications that require surgical intervention, despite the advances in medical treatment and changes in the natural history of disease. The clinical surgeon must make a decision about performing "selective vagotomy antrectomy versus highly selective vagotomy," based on the information discussed herein. The goals for operative treatment remain safe correction of the presenting problem, avoidance of perioperative morbidity and mortality, and freedom from disabling postoperative side effects. This paper addresses broad aspects of the details of surgical interventions; because most operative procedures are performed in urgent circumstances in patients who often have a variety of conditions, it is not surprising that there is no best operation suited to every complication of ulcer.

Vagotomy During Hiatal Hernia Repair: A Benign Esophageal Lengthening Procedure

“…Gastric or esophageal resection distorts the gastric anatomy and may also disturb the migrating motor complex. 32,38 These factors may lead to delayed gastric emptying and Visual analog scale 1-10 (1 = no symptoms; 10 = most severe). Dumping indicated by percentage of patients who experienced symptoms dumping syndrome more than vagotomy itself.…”

Trends and Predictors for Vagotomy When Performing Oversew of Acute Bleeding Duodenal Ulcer in the United States

“…These include truncal vagotomy for a compromised patient or a highly selective or truncal vagotomy for an ideal surgical candidate. 10 Still, the goals of ulcer surgery have not changed: safe correction of the bleeding, avoidance of perioperative morbidity and mortality, and freedom from disabling postoperative side effects. However, with the advances in endoscopic management of duodenal bleeds, improvements in medical therapy for acid hypersecretion and recognition of the role of H. pylori in ulcer pathogenesis, acid reducing surgical therapy for a bleeding duodenal ulcer appears to have gone by the wayside.…”

Surgical Management of Ulcer Disease

“…Operative suppression of acid secretion is associated with decreased persistence or recurrence of hemorrhage. Historically, the data suggested that a more aggressive suppression of acid secretion (ie, subtotal gastric resection) was more likely to prevent recurrence of hemorrhage than a lesser procedure such as limited 926 MARTIN antrectomy [8], and that eradication of neural stimulation of acid secretion allows for better results with lesser degrees of gastric resection [30]. Similarly, reduction of the degree of vagal interruption to the stomach is associated with an increase in the likelihood of ulcer recurrence or recurrence of hemorrhage.…”

“…Truncal vagotomy was introduced by Dragstedt and colleagues to attempt to eliminate the need for subtotal gastrectomy for effective treatment of ulcers [30]. The procedure requires division of the vagal trunks above the first branches to the gastric cardia and fundus, the criminal nerve of Grassi.…”

“…Because the pylorus is innervated predominantly by the posterior branch of the vagus in a small percentage of patients, a pyloroplasty may be required. Some authors recommend performing a pyloroplasty in conjunction with this procedure routinely [30].…”