Vagotomy
Encyclopedia
A vagotomy is a surgical
procedure that involves resection
of the vagus nerve
.
. It was once considered the gold standard but is now usually reserved for patients who have failed the first-line "triple therapy" against Helicobacter pylori
infection: 2 antibiotics (clarithromycin
and amoxicillin
or metronidazole
) and a proton pump inhibitor
(e.g. omeprazole
). It is also used in the treatment of gastric outlet obstruction
.
The use of vagotomy to treat obesity
is being studied. Early results show an average of 18% weight loss.
Vagotomy may have an impact upon ghrelin
.
. It was thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach
, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the peptic cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of 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 efficiently absorb Vitamin B12 from food, and injections or large oral doses of the vitamin may be required after such a procedure in certain populations.
. Other techniques focus on branches leading from the retroperitoneum to the stomach or by selecting only those branches that appear to supply peptic cells (highly selective vagotomy).
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
procedure that involves resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
of the vagus nerve
Vagus nerve
The vagus nerve , also called pneumogastric nerve or cranial nerve X, is the tenth of twelve paired cranial nerves...
.
Applications
Truncal vagotomy is a treatment option for chronic duodenal ulcersPeptic ulcer
A peptic ulcer, also known as PUD or peptic ulcer disease, is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm...
. It was once considered the gold standard but is now usually reserved for patients who have failed the first-line "triple therapy" against Helicobacter pylori
Helicobacter pylori
Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...
infection: 2 antibiotics (clarithromycin
Clarithromycin
Clarithromycin is a macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia , skin and skin structure infections...
and amoxicillin
Amoxicillin
Amoxicillin , formerly amoxycillin , and abbreviated amox, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral...
or metronidazole
Metronidazole
Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....
) and a proton pump inhibitor
Proton pump inhibitor
Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today. The group followed and has largely superseded another group of pharmaceuticals with similar...
(e.g. omeprazole
Omeprazole
Omeprazole is a proton pump inhibitor used in the treatment of dyspepsia, peptic ulcer disease , gastroesophageal reflux disease , laryngopharyngeal reflux and Zollinger–Ellison syndrome...
). It is also used in the treatment of gastric outlet obstruction
Gastric outlet obstruction
Gastric outlet obstruction is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into...
.
The use of vagotomy to treat obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
is being studied. Early results show an average of 18% weight loss.
Vagotomy may have an impact upon ghrelin
Ghrelin
Ghrelin is a 28 amino acid peptide and hormone that is produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone...
.
History
Vagotomy was once popular as a way of treating and preventing peptic ulcer disease and subsequent ulcer perforationsPerforated ulcer
A perforated ulcer, is a very serious condition where an untreated ulcer can burn through the wall of the stomach , allowing digestive juices and food to leech into the abdominal cavity. Treatment generally requires immediate surgery...
. It was thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the peptic cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of gastroesophageal reflux in those who suffered from it. The incidence of vagotomy decreased following the discovery by Barry Marshall
Barry Marshall
Barry James Marshall, AC, FRS, FAA is an Australian physician, Nobel Prize laureate in Physiology or Medicine, and Professor of Clinical Microbiology at the University of Western Australia. Marshall is well-known for proving that the bacterium Helicobacter pylori Barry James Marshall, AC, FRS, FAA...
and Robin Warren
Robin Warren
John Robin Warren AC is an Australian pathologist, Nobel Laureate and researcher who is credited with the 1979 re-discovery of the bacterium Helicobacter pylori, together with Barry Marshall.- Life and career :...
that H. pylori
Helicobacter pylori
Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...
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
Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
deficiency. As vagotomy decreases gastric secretion, Intrinsic Factor
Intrinsic factor
Intrinsic factor also known as gastric intrinsic factor is a glycoprotein produced by the parietal cells of the stomach. It is necessary for the absorption of vitamin B12 later on in the small intestine...
production can be impaired. Intrinsic factor is needed to efficiently absorb Vitamin B12 from food, and injections or large oral doses of the vitamin may be required after such a procedure in certain populations.
Types
A plain vagotomy eliminates the parasympathetic supply from the stomach to the left side of the transverse colonTransverse colon
The transverse colon, the longest and most movable part of the colon, passes with a downward convexity from the right hypochondrium region across the abdomen, opposite the confines of the epigastric and umbilical zones, into the left hypochondrium region, where it curves sharply on itself beneath...
. Other techniques focus on branches leading from the retroperitoneum to the stomach or by selecting only those branches that appear to supply peptic cells (highly selective vagotomy).