Supradiaphragmatic Vagotomy in Gastrojejunal Ulceration Following Subtotal Gastrectomy for Duodenal Ulcer

Weinstein, Vernon A.; Colp, Ralph

doi:10.1016/s0039-6109(16)32079-5

Cited by 9 publications

(2 citation statements)

References 3 publications

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“…Reports of thoracic vagotomy were published as early as the 1940s and 1950s. [14][15][16][17] This approach was usually used in patients with a marginal ulcer at the gastrojejunostomy after partial gastrectomy. The thoracic approach allowed surgeons to avoid the previously operated area with its adhesions and there was no risk of delayed gastric emptying because the pylorus had already been resected.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Thoracoscopic Truncal Vagotomy in the Treatment of Marginal Ulcers after Laparoscopic Roux-en-Y Gastric Bypass

Hunter

Stahl

Kakade

et al. 2012

The American Surgeon™

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Marginal ulcer is a significant complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Most marginal ulcers resolve with medical management, but nonhealing ulcers may require revision of the gastrojejunostomy, a procedure with significant morbidity and mortality. Traditionally, surgical therapy for refractory peptic ulcers includes a vagotomy. The current study evaluates the effectiveness of thoracoscopic truncal vagotomy (TTV) in the management of refractory marginal ulcers. All patients at two institutions with an intractable marginal ulcer after LRYGB treated with TTV between 2003 and 2010 were reviewed. Data were collected from chart review and telephone interview. Seventeen patients (mean age, 39 ± 13 years; 16 females) were diagnosed with marginal ulceration a median of 18 months after LRYGB and proceeded to TTV at a mean of 39 ± 43 weeks (range, 1 to 114 weeks) after the diagnosis. The median operative time was 89 ± 65 minutes (range, 45 to 318 minutes). Four patients had a complication (sympathetic contralateral pleural effusion, pneumothorax, operative bleeding, and readmission for emesis). Eleven patients had follow-up of 3 months to 6 years (median, 7 months). Nine patients (82%) had symptomatic improvement and/or endoscopic resolution, whereas two (18%) did not. No patient had endoscopic evidence of persistent or recurrent marginal ulcer. TTV achieves symptomatic improvement and/or endoscopic resolution of intractable marginal ulcers in over 80 per cent of patients status post gastric bypass and therefore offers a less morbid alternative to revision of the gastrojejunostomy.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Thoracoscopic Truncal Vagotomy in the Treatment of Marginal Ulcers after Laparoscopic Roux-en-Y Gastric Bypass

Hunter

Stahl

Kakade

et al. 2012

The American Surgeon™

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“…Different approaches exist, but a thoracic approach for truncal vagotomy was first described in the 1940s. 1 Evolution of minimally invasive surgery has decreased the use of open approaches and resulted in thoracoscopic surgery. The robotic approach provides excellent visualization, minimal blood loss, and safe mobilization of the esophagus.…”

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confidence: 99%