The influence of the vagus nerves on the biliary system

Abstract

Vagotomy has become accepted as a standard operation for the treatment of peptic ulcer during the past 15 years. Although used to treat a specific lesion in the stomach or duoddenum, vagus division can have a much wider effect on the digestive system, but little attentionhas been paid by most surgeons to the efffects of the vagus on other organs and it is timely to review the influence of the vagus nerves on the biliary system. In 1887 Ruggero Oddi suggested that the sphincter which is named after him was partly controlled by a nervous reflex. Since then many anatomists, physiologists, and clinicians have investigated the effects of the vagus nerves on the biliary system. The anatomical distribution of the vagus nerve and its hepatic and coeliac branches has been more thoroughly worked out than have their physiological effects.

Effects of Gastrectomy on Motility, Perfusion Pressure, and Caerulein-Induced Relaxation of Sphincter of Oddi in Dogs.

“…In the present study, although the cannulae inserted in the common bile duct were tied with its wall containing the neurons on the serosa (Hopton, 1973), caerulein induced the relaxation response on the SO in the preoperative and sham operated dogs. That the excitatory response of the SO to caerulein was only induced by gastrectomy indicates that the SO motility was reflexly controlled by the neuronal regulation from the stomach and/or uppermost duodenum.…”

“…If the reversed response to caerulein was induced by cholecystrectomy alone (Rolny et al, 1986) and sectioning of the nerves surrounding the common bile duct (Hopton, 1973), the reversed response should have been indicated after tying the common bile duct with cannula in the normal and sham operated dogs in the present experiment. However, caerulein induced the relaxation response on the SO after tying the cannulae with its wall of the common bile duct.…”

“…Rolny et al (1986) have demonstrated that, in patients with biliary dyskinesia after cholecystrectomy, intravenous application of caerulein with bolus induced an increase in basal perfusion pressure and the amplitude of phasic contractions of the SO, but Mizutani et al (1978) reported that cholecystrectomy had no effects to the caerulein-induced inhibitory response of the canine SO. Hopton (1973) described that the reflex from the gallbladder to the SO was terminated by transection of the common bile duct with its surrounding nerve plexus. Wyatt (1967) reported that electrical or mechanical stimulation of the antrum sometimes decreased the SO perfusion pressure, and suggested that these responses were probably induced by the intrinsic nervous pathway from the stomach.…”

Increased risk of cholelithiasis after esophagectomy

“…Gastrectomy has been considered as another risk factor for cholelithiasis . Truncal vagotomy during peptic ulcer surgery is associated with the development of cholelithiasis ,14. Hauters et al1 reported a high incidence of cholelithiasis (47%) after total gastrectomy and concluded that vagotomy performed during the resection may have contributed to the development of cholelithiasis.…”

“…Truncal vagotomy results in gallbladder hypomotility, 1-12 biliary stasis, 1,[3][4][5][8][9][10][11][12] and various changes in bile composition, 5,[8][9][10][11][12][13][14][15] all of which were considered to enhance gallstone formation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Total gastrectomy involves truncal vagotomy and is a high-risk procedure for the development of cholelithiasis. [1][2][3] As truncal vagotomy is an integral part of esophagectomy, we hypothesized that esophagectomy would also predispose to gallstone formation.…”