-
Current Neuropharmacology 2016Vagotomy reduces gastric acid secretion and was therefore introduced as a surgical treatment for peptic ulcers in the 1970s. Later, it was replaced by acid reducing... (Review)
Review
Vagotomy reduces gastric acid secretion and was therefore introduced as a surgical treatment for peptic ulcers in the 1970s. Later, it was replaced by acid reducing medication, such as histamine type 2 (H2) receptor antagonists and proton pump inhibitors (PPIs). A large body of evidence has indicated that drug-induced hypochlorhydria per se does not increase the risk of gastric cancer. Early studies on the effects of vagotomy in chemically-induced rodent models of gastric cancer reported an increased risk of developing gastric cancer. This was most likely due to a delayed gastric emptying, which later has been accounted for by including an additional drainage procedure, e.g. pyloroplasty. In a recent study using three different mouse models of gastric cancer (including genetically engineered, chemically-induced and Helicobacter pylori-infected mice), either unilateral vagotomy or bilateral truncal vagotomy with pyloroplasty was found to significantly attenuate tumorigenesis in the denervated side of the stomach at early preneoplastic stages as well as at later stages of tumorigenesis. Consistently, pharmacological denervation using botulinum toxin A or muscarinic acetylcholine receptor 3 (M3R) blockade inhibited tumorigenesis. Moreover, it was found that recurrence of gastric cancer was reduced in patients following vagotomy. Thus, these new findings suggest the potential treatment strategies to target the nerve, neurotransmitters, corresponding receptors and their downstream signaling pathways for the malignancy.
Topics: Animals; Carcinogenesis; Humans; Stomach Neoplasms; Vagotomy
PubMed: 26791481
DOI: 10.2174/1570159x14666160121114854 -
American Journal of Physiology.... Jun 2021The nucleus tractus solitarii (nTS) is the initial site of integration of sensory information from the cardiorespiratory system and contributes to reflex responses to...
The nucleus tractus solitarii (nTS) is the initial site of integration of sensory information from the cardiorespiratory system and contributes to reflex responses to hypoxia. Afferent fibers of the bilateral vagus nerves carry input from the heart, lungs, and other organs to the nTS where it is processed and modulated. Vagal afferents and nTS neurons are integrally associated with astrocytes and microglia that contribute to neuronal activity and influence cardiorespiratory control. We hypothesized that vagotomy would alter glial morphology and cardiorespiratory responses to hypoxia. Unilateral vagotomy (or sham surgery) was performed in rats. Prior to and seven days after surgery, baseline and hypoxic cardiorespiratory responses were monitored in conscious and anesthetized animals. The brainstem was sectioned and caudal, mid-area postrema (mid-AP), and rostral sections of the nTS were prepared for immunohistochemistry. Vagotomy increased immunoreactivity (-IR) of astrocytic glial fibrillary acidic protein (GFAP), specifically at mid-AP in the nTS. Similar results were found in the dorsal motor nucleus of the vagus (DMX). Vagotomy did not alter nTS astrocyte number, yet increased astrocyte branching and altered morphology. In addition, vagotomy both increased nTS microglia number and produced morphologic changes indicative of activation. Cardiorespiratory baseline parameters and hypoxic responses remained largely unchanged, but vagotomized animals displayed fewer augmented breaths (sighs) in response to hypoxia. Altogether, vagotomy alters nTS glial morphology, indicative of functional changes in astrocytes and microglia that may affect cardiorespiratory function in health and disease.
Topics: Animals; Astrocytes; Hypoxia; Male; Microglia; Neuroglia; Neurons; Rats, Sprague-Dawley; Solitary Nucleus; Vagotomy; Vagus Nerve; Rats
PubMed: 33978480
DOI: 10.1152/ajpregu.00019.2021 -
The Journal of Trauma and Acute Care... Jul 2022Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved...
BACKGROUND
Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations.
CONTENT VIDEO DESCRIPTION
A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy.
CONCLUSION
Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction.
LEVEL OF EVIDENCE
Video procedure and technique, not applicable.
Topics: Duodenal Ulcer; Gastrectomy; Humans; Peptic Ulcer; Peptic Ulcer Perforation; Vagotomy
PubMed: 35358158
DOI: 10.1097/TA.0000000000003636 -
British Medical Journal Sep 1972The incidence of diarrhoea after three types of vagotomy was assessed "blind" at a gastric follow-up clinic one year after operation. Diarrhoea was recorded in 24% of...
The incidence of diarrhoea after three types of vagotomy was assessed "blind" at a gastric follow-up clinic one year after operation. Diarrhoea was recorded in 24% of patients after truncal vagotomy and pyloroplasty, in 18% after selective vagotomy and pyloroplasty, but in only 2% of patients after highly selective vagotomy without a drainage procedure. The incidence of diarrhoea was significantly less (P < 0.01) after highly selective vagotomy than after either of the other procedures.Hypertonic glucose solution given by mouth to 15 representative patients from each group and to 15 patients before operation provoked the onset of diarrhoea in 67% of the patients who had undergone truncal vagotomy and pyloroplasty, in 60% of those who had undergone selective vagotomy and pyloroplasty, in 13% of those who had undergone highly selective vagotomy without a drainage procedure, and in none of the preoperative patients. Again the difference between the "highly selective" group and the other two groups of vagotomized patients was statistically significant.It is suggested that postvagotomy diarrhoea is attributable both to unregulated gastric emptying after truncal or selective vagotomy with a drainage procedure and to the extragastric denervation produced by truncal vagotomy. "Postvagotomy" diarrhoea can be virtually eliminated by using highly selective vagotomy without a drainage procedure.
Topics: Diarrhea; Duodenal Ulcer; Follow-Up Studies; Gastrointestinal Motility; Glucose; Humans; Hypertonic Solutions; Methods; Pylorus; Vagotomy
PubMed: 5076248
DOI: 10.1136/bmj.3.5830.788 -
NeuroImage Nov 2022Interactions between the brain and the stomach shape both cognitive and digestive functions. Recent human studies report spontaneous synchronization between brain...
Interactions between the brain and the stomach shape both cognitive and digestive functions. Recent human studies report spontaneous synchronization between brain activity and gastric slow waves in the resting state. However, this finding has not been replicated in any animal models. The neural pathways underlying this apparent stomach-brain synchrony is also unclear. Here, we performed functional magnetic resonance imaging while simultaneously recording body-surface gastric slow waves from anesthetized rats in the fasted vs. postprandial conditions and performed a bilateral cervical vagotomy to assess the role of the vagus nerve. The coherence between brain fMRI signals and gastric slow waves was found in a distributed "gastric network", including subcortical and cortical regions in the sensory, motor, and limbic systems. The stomach-brain coherence was largely reduced by the bilateral vagotomy and was different between the fasted and fed states. These findings suggest that the vagus nerve mediates the spontaneous coherence between brain activity and gastric slow waves, which is likely a signature of real-time stomach-brain interactions. However, its functional significance remains to be established.
Topics: Humans; Rats; Animals; Stomach; Vagus Nerve; Brain; Vagotomy; Neural Pathways
PubMed: 36113737
DOI: 10.1016/j.neuroimage.2022.119628 -
The Yale Journal of Biology and Medicine 1994The treatment of the peptic ulcer disease involves several options. The present discussion deals with the long-term management with emphasis on the application of... (Review)
Review
The treatment of the peptic ulcer disease involves several options. The present discussion deals with the long-term management with emphasis on the application of vagotomy. Eradication of Helicobacter pylori is the treatment of choice in ordinary peptic ulcer patients. Exceptions are non-steroidal, anti-inflammatory drug-induced ulcers and the Zollinger-Ellison syndrome. Failures to eradicate H. pylori in old or unfit duodenal ulcer patients and most gastric ulcer patients will lead to intermittent antisecretory treatment or continuous maintenance treatment. Maintenance treatment will usually mean lifelong treatment, and optimal results are probably obtained with a full-dose antisecretory regime. Failures to eradicate H. pylori in young and fit duodenal ulcer patients is the group of patients to whom proximal gastric vagotomy can still be recommended as an elective surgical procedure. The proximal gastric vagotomy should preferably be performed with the laparoscopic technique. Evidence is presented that completeness of vagotomy is of clinical importance. The completeness of vagotomy can be tested and defined.
Topics: Duodenal Ulcer; Gastric Acid; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer; Vagotomy
PubMed: 7502524
DOI: No ID Found -
International Journal of Molecular... Aug 2022TBI induces splenic B and T cell expansion that contributes to neuroinflammation and neurodegeneration. The vagus nerve, the longest of the cranial nerves, is the...
TBI induces splenic B and T cell expansion that contributes to neuroinflammation and neurodegeneration. The vagus nerve, the longest of the cranial nerves, is the predominant parasympathetic pathway allowing the central nervous system (CNS) control over peripheral organs, including regulation of inflammatory responses. One way this is accomplished is by vagus innervation of the celiac ganglion, from which the splenic nerve innervates the spleen. This splenic innervation enables modulation of the splenic immune response, including splenocyte selection, activation, and downstream signaling. Considering that the left and right vagus nerves have distinct courses, it is possible that they differentially influence the splenic immune response following a CNS injury. To test this possibility, immune cell subsets were profiled and quantified following either a left or a right unilateral vagotomy. Both unilateral vagotomies caused similar effects with respect to the percentage of B cells and in the decreased percentage of macrophages and T cells following vagotomy. We next tested the hypothesis that a left unilateral vagotomy would modulate the splenic immune response to a traumatic brain injury (TBI). Mice received a left cervical vagotomy or a sham vagotomy 3 days prior to a fluid percussion injury (FPI), a well-characterized mouse model of TBI that consistently elicits an immune and neuroimmune response. Flow cytometric analysis showed that vagotomy prior to FPI resulted in fewer CLIP+ B cells, and CD4+, CD25+, and CD8+ T cells. Vagotomy followed by FPI also resulted in an altered distribution of CD11b and CD11b macrophages. Thus, transduction of immune signals from the CNS to the periphery via the vagus nerve can be targeted to modulate the immune response following TBI.
Topics: Animals; Brain Injuries, Traumatic; Disease Models, Animal; Mice; Spleen; Vagotomy; Vagus Nerve
PubMed: 36077246
DOI: 10.3390/ijms23179851 -
British Medical Journal Mar 1968
Topics: Diarrhea; Gastric Juice; Humans; Postoperative Complications; Vagotomy
PubMed: 5641501
DOI: 10.1136/bmj.1.5595.840-b -
British Medical Journal Feb 1970
Topics: Celiac Disease; Diagnosis, Differential; Diarrhea; Duodenal Ulcer; Gastroenterostomy; Humans; Male; Middle Aged; Pyloric Stenosis; Vagotomy
PubMed: 5434662
DOI: 10.1136/bmj.1.5693.412 -
Postgraduate Medical Journal Nov 1950
Topics: Humans; Peptic Ulcer; Pylorus; Vagotomy
PubMed: 14786081
DOI: 10.1136/pgmj.26.301.575