Definition and Overview

Vagotomy is a surgical procedure that removes the vagus nerves for the treatment of peptic, gastric, and duodenal ulcers.

The vagus nerves are found in the stomach and are responsible for stimulating acid secretion, which helps digest or break down the food before the nutrients are delivered into the small intestine. If there’s too much acid, it can create ulcerations in the stomach walls resulting in excessive bleeding, which can be a life-threatening condition.

In the past, vagus nerve removal is the first line of treatment for peptic ulcers. However, advances in the field of medicine have paved the way for the introduction of effective drugs that eliminate the need for this surgery in certain cases.

Who Should Undergo and Expected Results

Vagus nerve removal is recommended:

  • For people diagnosed with peptic or gastric ulcers – In the United States, at least 30% of the adult population, including those who remain undiagnosed, have a peptic ulcer. A gastric disease, its common signs and symptoms are heartburn, bloating, pain around the abdominal area especially after each meal, and nausea. Some people also experience vomiting.

  • For those whose condition does not respond to medications or lifestyle modifications – Drug therapy and change in lifestyle, particularly following a certain diet and smoking cessation, are now the primary treatments for peptic ulcers. If the patient’s illness continues to progress or worsen or if he doesn’t respond to any medication, surgery is considered.

  • If the condition has become chronic – Patients whose conditions respond to medications but experience recurrences, are also candidates for this procedure.

  • If the situation is deemed an emergency – It is an emergency if the patient is diagnosed with peritonitis (peritoneum inflammation) due to perforation of the stomach or obstruction and bleeding in the upper GI (gastrointestinal) tract.
    It is expected that the patient will recover normally after the procedure. However, the surgery doesn’t entirely guarantee that peptic ulcers won’t come back.

How Does the Procedure Work?

Vagus nerve removal can be performed in three ways depending on what the gastrointestinal surgeon thinks is best for the patient based on his condition and unique circumstances. The first option is total abdominal or truncal approach, wherein the entire truck of the vagus nerve is divided and drainage provided. It is often performed in patients with chronic duodenal ulcer.

The approach is considered highly selective (HSV) if only the section of the stomach that contains the parietal cells and the fundus are removed but the nerve supply to the pancreas and liver, among others, is retained. If only a section of the intercostal space is removed, the procedure is called thorascopic vagotomy.

Regardless of the surgical approach, the procedure is performed under general anaesthesia and the patient is connected to a machine that monitors his blood pressure and heart rate throughout the surgery. The surgeon then makes a long incision in the abdominal area to access the stomach. If it’s a laparoscopic procedure, which is minimally invasive, at least four small incisions in the abdomen are made where the laparoscope and specially designed surgical tools are inserted. Carbon dioxide is then introduced through one of the incision to expand the abdomen so the surgeon can easily locate the vagus nerve and excises the trunk and/or the branches.

Once the procedure is over, the incisions are closed. The patient normally stays in the hospital for five days to a week. In the first few days, the nurse may have to suction the stomach content through the nose.

Possible Risks and Complications

Vagus nerve removal has certain risks including changes in digestive patterns. Pyloroplasty is often performed to empty the stomach into the small intestine. The patient may also develop an infection, bleeding, perforation, and minor to severe discomfort and pain.

References:

  • Schroder VT, Pappas TN, Vaslef SN, De La Fuente SG, Scarborough JE. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014 Jun. 259 (6):1111-8. [Medline].
  • Lo Menzo E, Stevens N, Kligman M. Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass. Surg Obes Relat Dis. 2011 Jun 30. [Medline].
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