Vagotomy is a method for the surgical treatment of gastric and duodenal ulcers. It is rarely used today. In most cases, acid suppression of the stomach with medication helps. Gastric resection has proven itself surgically.
Here you will find further information as well as selected specialists and centers for a vagotomy.
Vagotomy is a surgical therapeutic procedure for the treatment of gastric and duodenal ulcers.
Vagotomy involves severing the two main branches of the vagus nerve (truncal vagotomy) or their branches. Among other things, they are responsible for acid production in the stomach. Acid production is carried out by the parietal cells in the fundus and corpus of the stomach. Acid secretion is stimulated by the nerve fibers of the vagus nerve.
The aim of the various vagotomy procedures is to suppress acid production . To do this, the surgeon cuts the nerve fibers that run to the stomach and duodenum at various points in the stomach.
In addition to vagotomy, the following procedures are also available:
Gastric or duodenal ulcers are caused by increased acid production in the stomach or by an imbalance. It is a deep-seated defect in the mucous membrane that can develop into a gastric rupture.
The causes of stomach or duodenal ulcers vary in nature:
Stomach inflammation is very painful and often occurs in older people @ New Africa /AdobeStockThe therapeutic agent of first choice is acid-inhibiting medication. They suppress acid production in the stomach (so-called proton pump inhibitors).
This has significantly reduced the number of vagotomies performed in the last two decades. However, drug therapy is not always sufficient or possible. In the case of a duodenal ulcer, vagotomy is therefore indicated.
Sufficient medication and antibiotic therapy can initially help. If the patient then develops a duodenal ulcer again, vagotomy is not advisable: acid suppression will not be significantly better after vagotomy than under drug-induced acid suppression.
The vagus nerve is the tenth cranial nerve. Once it enters the chest cavity, it is a purely parasympathetic nerve. It enters the abdominal cavity through the diaphragm (oesophageal hiatus).
Its supply area extends from the stomach via the small intestine down to the large intestine. The nerve ends in the so-called Cannon-Böhm point, which is located in the area of the left flexure of the large intestine.
The vagus nerve supplies all organs to be innervated parasympathetically from the neck area to the left colonic flexure.
It is the only cranial nerve that innervates beyond the head and neck region.
In the digestive tract, it ensures
During its passage from the thoracic cavity into the abdominal cavity, the vagus nerve divides into two trunks:
Anatomical course of the vagus nerve @ pikovit /AdobeStockThere are three vagotomy procedures:
Selective proximal vagotomy (SPV)
In a selective proximal vagotomy, doctors cut all anterior and posterior vagus branches that run to the fundus and corpus. The motor branches, which are responsible for gastric motility, remain intact. This means that only the secretory vagus branches are cut off.
The nerve supply to the antrum and pylorus remains intact. This prevents gastric emptying disorders.
Doctors must not overlook the criminal ramus during a selective proximal vagotomy. This nerve branch has fibers that run to the fundus ventriculi. They thus stimulate acid production in the upper section of the stomach. They must seek out and stop this branch.
The selective proximal vagotomy ends with the ligation of the gastroepiploic ramus nerve branch in the area of the large curvature of the stomach.
Selective gastric vagotomy (SGV)
In a selective gastric vagotomy, all branches of the vagus nerve that run to the stomach are cut. This also includes the nerve fibers to the pylorus.
Only the branches to the liver and coeliac ganglion are spared.
This procedure results in a gastric emptying disorder. A drainage procedure (pyloroplasty or pyloromyotomy) is therefore always necessary.
Truncular vagotomy (TV)
In a truncal vagotomy, both trunks of the vagus nerve are severed near the diaphragm. This leads to a complete denervation of the entire supply area in the abdominal cavity.
A drainage procedure is also mandatory here.
This procedure is no longer used today due to the significant sequelae.
The most common complication after a vagotomy is gastric emptying disorder, with a probability of around 20 percent . It occurs in particular after a truncal vagotomy (TV).
This is the result of insufficient relaxation of the muscles in the area of the stomach outlet (pylorospasm). As a result, a second operation is usually necessary.
The second most common complication after a vagotomy is the recurrence of an ulcer, which accounts for around 6 to 10 percent of cases. This is caused by an inadequately performed vagotomy.
Spleen and esophageal injuries are observed in 1 to 2 percent of cases. Diarrhea or meteorism occur less frequently (approx. 1 percent).
After complete recovery, no relevant restrictions in everyday life are generally to be expected after vagotomy.
If surgical treatment of a gastric or duodenal ulcer is necessary, gastric resection is superior to the various vagotomy procedures.
Today, vagotomy is only used in the rarest of cases. It has almost been replaced by the use of drug-based acid suppression in the stomach.
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