Proximal gastric vagotomy by minimally invasive methods in an acute rat model

Abstract

In this prospective study, minimally invasive methods of proximal gastric vagotomy (PGV) were investigated in male Sprague-Dawley rats. Completeness of vagotomy by traditional operative therapy, by laser denervation of the gastric serosa, and by subserosal or transmucosal injections of chemoneurolytic agents was evaluated with postoperative Congo red testing, ulcerogenic stimulation of the gastric mucosa, and histochemical labeling of whatever vagal fibers remained in the gastric wall. Short-term results demonstrate that successful PGV can be performed with minimally invasive methods.

Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy

“…These methods employed were identical to previous minimally invasive PGVs performed in this rat model [33,43,49].…”

“…Due to the performance of a gastrotomy in the transmucosal injection rats, perioperative antibiotics were administered to all the animals during the initial peritoneal anesthetic injection of pentobarbital (30-40 mg/kg and the transperitoneal cefazolin 25 mg/kg). Sham and standard operative PGV control animals were prepared in the usual fashion [33,43,49]. Anterior and posterior gastric fundic injections (a total of 10-12 per animal) either transmucosally or transserosally were performed with the following experimental injection groups: saline control or 0.625, 1.25, 2.5, 5, or 10 mg BAC/kg.…”

“…Anterior and posterior gastric fundic injections (a total of 10-12 per animal) either transmucosally or transserosally were performed with the following experimental injection groups: saline control or 0.625, 1.25, 2.5, 5, or 10 mg BAC/kg. In all of the transmucosal gastric injected rats, a gastrotomy on the greater curvature of the stomach was performed and transmucosal injections were performed as previously described [33,49]. The gastrotomies were closed with a running 4-0 Vicryl suture (Polyglactin 910, Ethicon, Somerville, NJ).…”

“…The development of new minimally invasive endoscopic (nonoperative) techniques which would pharmacologically denervate acid-secreting parietal cells of the stomach could contribute alternatives to the short-and long-term management of peptic ulcer disease. Previous rat and porcine studies have evaluated the ability of laser laparoscopic and chemoneurolytic endoscopic techniques to produce proximal gastric vagotomies (PGV) [33,[43][44][45][46][47][48][49]. Benzalkonium chloride (12-, 14-, and 16-carbon-chain-length homologs of N-alkyl-dimethylbenzylammonium chloride [BAC]) has been identified as the most appropriate chemoneurolytic agent to produce a PGV [33,45,49].…”

“…Previous rat and porcine studies have evaluated the ability of laser laparoscopic and chemoneurolytic endoscopic techniques to produce proximal gastric vagotomies (PGV) [33,[43][44][45][46][47][48][49]. Benzalkonium chloride (12-, 14-, and 16-carbon-chain-length homologs of N-alkyl-dimethylbenzylammonium chloride [BAC]) has been identified as the most appropriate chemoneurolytic agent to produce a PGV [33,45,49]. In the porcine model, BAC gastroscopically injected into Congo red-stained, acid-secreting, gastric submucosa shows promise as a permanent, nontoxic method of ablating acidsecreting areas of the stomach.…”