Vagotomy

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Vagotomy
Course and distribution of the glossopharyngeal, vagus, and accessory nerves.
ICD-9-CM44.0
MeSHD014628

A vagotomy is a surgical procedure that involves removing part of the vagus nerve. It is performed in the abdomen.

Types

A plain vagotomy eliminates the

parasympathetic supply from the stomach to the left side of the transverse colon. Other techniques focus on branches leading from the retroperitoneum to the stomach.[1]

Highly selective vagotomy refers to denervation of only those branches supplying the lower esophagus and stomach (leaving the nerve of Latarjet in place to ensure the emptying function of the stomach remains intact). It is one of the treatments of peptic ulcer.

Vagotomy is an essential component of surgical management of peptic (duodenal and gastric) ulcer disease (PUD). Vagotomy was once commonly performed to treat and prevent PUD; however, with the availability of excellent acid secretion control with H2 receptor antagonists, such as cimetidine, ranitidine, and famotidine, and proton pump inhibitors (PPIs), such as pantoprazole, rabeprazole, omeprazole, and lansoprazole, the need for surgical management of peptic ulcer disease has greatly decreased.[2]

The basic types of vagotomy are:

  • Truncal vagotomy (TV) includes division of the main trunk of the vagus (including its celiac/hepatic branch) and denervation of the pylorus; therefore, a pyloric drainage procedure, such as pyloric dilatation or disruption (pyloromyotomy or pyloroplasty) or gastrojejunostomy, is needed. This procedure also denervates the liver, biliary tree, pancreas, and small and large bowel.[2]
  • Highly selective vagotomy includes denervation of only the fundus and body (parietal cell-containing areas) of the stomach (also called parietal cell vagotomy). It preserves the nerve supply of the antrum and pylorus; a pyloric drainage procedure is not needed. It does not denervate the liver, biliary tree, pancreas, or small and large bowel. This procedure is also called proximal gastric vagotomy.[3]

All types of vagotomy can be performed at open surgery (laparotomy) or using minimally invasive surgery (laparoscopy).

For the management of PUD, vagotomy is sometimes combined with antrectomy (removal of the distal half of the stomach) to reduce the rate of recurrence. Reconstruction is performed with gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II). It is left intact in highly selective vagotomy so the function of gastric emptying remains intact.[4]

Applications

Truncal vagotomy is a treatment option for chronic duodenal ulcers.

proton pump inhibitor (e.g., omeprazole). It is also used in the treatment of gastric outlet obstruction.[7][8]

In 2007 the use of vagotomy to treat

ventromedial hypothalamus (VMH), the brain's feeding and satiety centers, respectively.[11][12] Animals with lesioned VMH will gain weight even in the face of severe restrictions imposed on their food intake, because they no longer provide the signaling needed to turn off energy storage and facilitate energy burning. In humans, the VMH is sometimes injured by ongoing treatment for acute lymphoblastic leukemia or surgery or radiation to treat posterior cranial fossa tumors.[10] With the VMH disabled and no longer responding to peripheral energy balance signals, "[e]fferent sympathetic activity drops, resulting in malaise and reduced energy expenditure, and vagal activity increases, resulting in increased insulin secretion and adipogenesis."[13] "VMH dysfunction promotes excessive caloric intake and decreased caloric expenditure, leading to continuous and unrelenting weight gain. Attempts at caloric restriction or pharmacotherapy with adrenergic or serotonergic agents have previously met with little or only brief success in treating this syndrome."[10]
The vagus nerve is thought to be one key mediator of these effects, as lesions lead to chronic elevations in insulin secretion, promoting energy storage in adipocytes. Vagotomy may have an impact upon
gastric dumping syndrome (n=3), wound infection (n=2), other (n=5), and diarrhea (n=6).[15]

History

Vagotomy was once popular as a way of treating and preventing PUD

gastroesophageal reflux in those who suffered from it. The incidence of vagotomy decreased following the discovery by Barry Marshall and Robin Warren that H. pylori is responsible for most peptic ulcers, because H. pylori can be treated much less invasively. One potential side effect of vagotomy is a vitamin B12 deficiency. As vagotomy decreases gastric secretion, intrinsic factor production can be impaired. Intrinsic factor is needed to absorb vitamin B12 efficiently from food, and injections or large oral doses of the vitamin may be required after such a procedure in certain populations.[19]

References

  1. PMID 8092897
    .
  2. ^
    PMID 30252360
    , retrieved 2021-05-06
  3. ^ "Highly Selective Vagotomy - an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 2021-05-06.
  4. ^ Surgical Treatment of Perforated Peptic Ulcer at eMedicine
  5. PMID 12625684
    .
  6. PMID 11438277
    .
  7. PMID 15630940
    .
  8. PMID 8678208
    .
  9. ^ "Could nerve-snipping spur weight loss? - USATODAY.com". USA Today. 2007-07-02. Retrieved 2010-05-27.
  10. ^
    PMID 12788859
    .
  11. PMID 14744442
    .
  12. ISBN 0-7216-3256-4
    .
  13. PMID 22654817
    .
  14. PMID 14525914
    .
  15. S2CID 2660393. Retrieved 17 June 2013.{{cite journal}}: CS1 maint: location (link
    )
  16. PMID 6422569
    .
  17. PMID 7114938
    .
  18. PMID 3401061
    .
  19. ^ "Home". pernicious-anaemia-society.org.

External links

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