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Annals of Surgery Jan 1989A prospective, randomized, controlled trial was conducted to compare truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
A prospective, randomized, controlled trial was conducted to compare truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy (PCV) as elective treatment for duodenal ulcer. Between 11 and 15 years after operation, 248 patients were available for study of the recurrent ulceration rate by a life table method, and 197 patients could be studied with regard to postvagotomy symptoms. The recurrent ulcer rates were 28.5% for TV, 37.4% for SV, and 39.3% for PCV. These differences were not statistically significant. The incidence of severe postvagotomy symptoms was as follows: dyspepsia, 18.4% for TV, 20.5% for SV, 8.6% for PCV; dumping, 5.9% for TV, 19.6% for SV, 2.2% for PCV; diarrhea, 9.8% for TV, 11.8% for SV, 4.4% for PCV. The incidence of severe dumping was significantly less frequent among the PCV patients than the SV group. The differences did not reach statistical significance in any of the other groups. There was no significant difference in the Visick gradings among the three groups either before or after treatment of the failures. About two thirds of the patients in each group were finally satisfied with their operation, often after second operations or prolonged medical treatment. It is concluded that none of the three forms of vagotomy can be recommended as the standard operative treatment of duodenal ulceration.
Topics: Clinical Trials as Topic; Drainage; Duodenal Ulcer; Evaluation Studies as Topic; Follow-Up Studies; Humans; Prospective Studies; Random Allocation; Recurrence; Reoperation; Time Factors; Vagotomy; Vagotomy, Proximal Gastric; Vagotomy, Truncal
PubMed: 2642689
DOI: 10.1097/00000658-198901000-00006 -
The British Journal of Surgery Jun 1993The completeness of vagotomy following proximal gastric vagotomy or anterior seromyotomy with posterior truncal vagotomy was assessed prospectively in 48 patients using...
The completeness of vagotomy following proximal gastric vagotomy or anterior seromyotomy with posterior truncal vagotomy was assessed prospectively in 48 patients using the intraoperative congo red test. Pentagastrin (6 micrograms/kg) was given subcutaneously before the assessment. An endoscope was passed into the stomach and 180 ml congo red solution washed over the gastric mucosa. Continuing acid production was indicated by the appearance of a black colour (pH < 3) 2 min after introduction of the dye. A grading system was adopted where grades I and II showed little black discoloration and grades III and IV showed increasing areas of discoloration indicating that further denervation was required. All 20 patients undergoing anterior seromyotomy with posterior vagotomy were classified as grade I. Fifteen of an initial 23 patients receiving proximal gastric vagotomy were grade III or IV. Following division of either the right gastroepiploic nerve or the posterior vagal trunk, 22 patients improved to grade I (16) or II (six). In the subsequent five proximal vagotomies, modification of the dissection produced grade I results. Anterior seromyotomy with posterior truncal vagotomy gave consistently complete vagotomy. The congo red test highlighted major differences in the adequacy of vagotomy achieved using various dissection techniques during proximal gastric vagotomy. The test is a useful, reproducible and simple intraoperative method for assessing the completeness of denervation.
Topics: Adolescent; Adult; Aged; Chronic Disease; Congo Red; Duodenal Ulcer; Female; Gastric Acidity Determination; Gastric Mucosa; Humans; Male; Middle Aged; Prospective Studies; Stomach; Vagotomy, Proximal Gastric; Vagotomy, Truncal
PubMed: 8330161
DOI: 10.1002/bjs.1800800625 -
Thorax Apr 1976Hiatal herniation caused by contraction of the longitudinal muscle of the oesophagus has been prevented by disconnecting the local vagal nerve supply while preserving... (Comparative Study)
Comparative Study
Hiatal herniation caused by contraction of the longitudinal muscle of the oesophagus has been prevented by disconnecting the local vagal nerve supply while preserving the vagal connections to more distant organs. A selective oesophageal vagotomy above the lung hilum may prove an effective adjunct to orthodox hiatal hernia repair in man.
Topics: Animals; Dogs; Esophagoplasty; Esophagus; Gastroesophageal Reflux; Hernia, Diaphragmatic; Hernia, Hiatal; Models, Biological; Muscle Contraction; Muscle Denervation; Pressure; Vagotomy
PubMed: 941108
DOI: 10.1136/thx.31.2.185 -
Annals of Surgery May 1985Transthoracic vagotomy was performed in 16 patients with postoperative peptic ulcer diagnosed by endoscopy. Transabdominal vagotomy had been attempted at a previous...
Transthoracic vagotomy was performed in 16 patients with postoperative peptic ulcer diagnosed by endoscopy. Transabdominal vagotomy had been attempted at a previous operation in 10 patients. Five patients had been treated previously by subtotal gastrectomy without vagotomy and one had had gastrojejunostomy without vagotomy. Three of the 16 patients had had no previous gastric resection. Before transthoracic vagotomy, the ratio of sham feeding-stimulated acid output (SAO) to peak pentagastrin-stimulated acid output (PAO) was greater than 0.10 in each patient, suggesting intact vagal innervation of the stomach (mean ratio: 0.44; range: 0.17-0.79). After transthoracic vagotomy, SAO and PAO decreased by 98 +/- 1% and 73 +/- 8%, respectively. There was no operative mortality, and a clinically important postoperative complication developed in only one patient. Two patients had delayed gastric emptying transiently, and three have developed diarrhea. No patient has developed recurrent peptic ulceration or ulcer complications during a mean follow-up period of 3.9 years (range: 1.0-7.5 years). This study indicates that: (1) sham feeding is useful for identifying patients to undergo transthoracic vagotomy, and (2) transthoracic vagotomy is a safe and effective means of reducing acid secretion and preventing peptic ulcer recurrence, regardless of previous operation.
Topics: Adult; Aged; Follow-Up Studies; Gastric Acid; Humans; Male; Middle Aged; Pentagastrin; Peptic Ulcer; Postoperative Complications; Recurrence; Reoperation; Vagotomy
PubMed: 3994436
DOI: 10.1097/00000658-198505000-00015 -
JSLS : Journal of the Society of... 1999This study illustrates our experience in treating duodenal ulcer by means of thoracoscopy and laparoscopy over a period of six years. (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
This study illustrates our experience in treating duodenal ulcer by means of thoracoscopy and laparoscopy over a period of six years.
MATERIALS AND METHODS
From October 1991 to October 1998, we submitted 38 patients (31 males and 7 females), average age 51 years (range 22-78 years), with duodenal ulcer to vagotomy with minimally invasive access: 23 Hill-Barkers, 2 Taylors, 9 thoracoscopic truncal vagotomies and 4 laparoscopic truncal vagotomies. The patients submitted to thoracoscopic truncal vagotomy had previous gastric surgery (5 ulcers of the neostoma in patients who had undergone gastric resection, 3 hemorrhagic gastritis of the gastric neostoma and 1 incomplete abdominal vagotomy).
RESULTS
The average time required for the thorascopic approach was 30 minutes (range 20-40 minutes) with return to normal feeding in 1 day, without any difficulty, and discharge on day 3 (range 2-5 days). The patients were followed for 3-54 months. Twenty-two patients (91.3%) out of 23 submitted to anterior superselective and posterior truncal vagotomy, and the patients submitted to thoracoscopic vagotomy, were pain free without medical therapy. One patient (4.3%) was lost to the follow-up. There was only one relapse (4.3%) after seven months where the patient underwent left thorascopic truncal vagotomy. We had no mortality and no intraoperative or postoperative complications.
CONCLUSIONS
In our opinion, minimally invasive treatment of peptic ulcer disease may represent the "gold standard." It is simple, quick, effective and delivers the same excellent results of open surgery but with minimum trauma.
Topics: Adult; Aged; Duodenal Ulcer; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Pain Measurement; Sensitivity and Specificity; Thoracoscopy; Treatment Outcome; Vagotomy
PubMed: 10527332
DOI: No ID Found -
Langenbecks Archiv Fur Chirurgie 1984
Topics: Humans; Necrosis; Postoperative Complications; Stomach; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6471990
DOI: 10.1007/BF01261064 -
Khirurgiia Apr 1986
Topics: Dumping Syndrome; Humans; Peptic Ulcer; Postoperative Complications; Time Factors; Vagotomy
PubMed: 3713041
DOI: No ID Found -
Voenno-meditsinskii Zhurnal Jan 1984
Comparative Study
Topics: Adult; Aged; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Peptic Ulcer; Recurrence; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6702110
DOI: No ID Found -
British Medical Journal Dec 1975In a world-wide survey of the results of 5539 highly selective vagotomies (HSVs) performed electively for duodenal ulcer the operative mortality was found to be 0-3%....
In a world-wide survey of the results of 5539 highly selective vagotomies (HSVs) performed electively for duodenal ulcer the operative mortality was found to be 0-3%. This was lower than that found in collected series after either vagotomy with drainage (0-8%) or gastric resection with or without vagotomy (over 1%). Necrosis of the lesser curvature occurred in 10 patients (0-2%) after HSV and caused death in 5(0-1%). Such necrosis is probably ischaemic in origin. Hence reperitonealisation of the raw area on the lesser curvature and prompt laparotomy if the patient develops signs of peritonitis might lower the mortality still further. Three deaths were due to pulmonary embolism, one to mesenteric vascular occlusion, and four to myocardial infarction; such deaths might be reduced by the prophylactic use of low-dose heparin. Persisting gastric stasis requiring drainage occurred in only 0-1% of the patients in the early postoperative period and in 0-6% of the patients later. Hence drainage procedures, which produce side effects such as early dumping, bilious vomiting, and diiarrhoea, could be abandoned if the mean incidence of recurrent ulceration after HSV remains close to its present level. HSV is probably the safest operation for duodenal ulcer because the alimentary tract is not opened and there is no anastomosis, suture line, or stoma.
Topics: Drainage; Duodenal Ulcer; Esophageal Diseases; Gastrointestinal Motility; Humans; Necrosis; Stomach Diseases; Vagotomy
PubMed: 1203664
DOI: 10.1136/bmj.4.5996.545 -
Surgical Endoscopy Aug 1998Results from classic highly selective vagotomy (HSV) are technique dependent because an incomplete operation will result in early recurrence of duodenal ulcer. Few... (Clinical Trial)
Clinical Trial
BACKGROUND
Results from classic highly selective vagotomy (HSV) are technique dependent because an incomplete operation will result in early recurrence of duodenal ulcer. Few reports describe laparoscopic completion of the procedure. All techniques use clips for division of neurovascular branches, making the laparoscopic approach tedious and thus the results, uncertain.
METHODS
Ten patients with intractable duodenal ulcer and negative Helicobacter pylori status underwent an extended HSV. All procedures were performed laparoscopically using a new surgical tool, the harmonic shears.
RESULTS
All procedures were completed laparoscopically and took approximately 1 h. There were no deaths and no postoperative complications. Patients were discharged the next day. Follow-up endoscopy at 2 months showed healing of duodenal ulcer in all cases, and postoperative acid secretion studies demonstrated a decrease in basal acid output (BAO) by 74% (8.2 meq/h to 2.16 meq/h) and maximal acid output (MAO) by pentagastrin stimulation by 79.2% (40 to 8.32).
CONCLUSIONS
Harmonic shears expedite laparoscopic HSV. The operation can be taught safely, yields good results in early follow-up, and represents an acceptable option in patients with intractable duodenal ulcers who are H. pylori negative.
Topics: Adult; Chronic Disease; Duodenal Ulcer; Follow-Up Studies; Humans; Laparoscopes; Laparoscopy; Ligation; Male; Middle Aged; Prognosis; Surgical Instruments; Treatment Outcome; Vagotomy
PubMed: 9685541
DOI: 10.1007/s004649900779