-
British Medical Journal Apr 1975An oral glucose tolerance test was performed in patients who had undergone truncal vagotomy and pyloroplasty, bilateral selective vagotomy and pyloroplasty, or highly... (Comparative Study)
Comparative Study
Effects of truncal, selective, and highly selective vagotomy on glucose tolerance and insulin secretion in patients with duodenal ulcer. Part I-Effect of vagotomy on response to oral glucose.
An oral glucose tolerance test was performed in patients who had undergone truncal vagotomy and pyloroplasty, bilateral selective vagotomy and pyloroplasty, or highly selective vagotomy without a drainage procedure at least six months earlier. The results were compared with those from patients with chronic duodenal ulcer before operation. In all three groups of patients after vagotomy more rapid rates of rise of blood glucose and higher peak concentrations were observed than in patients who were tested before operation. These differences were statistically significant only in patients who had undergone truncal or selective vagotomy with pyloroplasty and were probably due to more rapid rates of gastric emptying after these operations. Plasma insulin concentrations were lower after truncal vagotomy than after selective or highly selective vagotomy, the difference between truncal vagotomy and highly selective vagotomy being statistically significant. Truncal vagotomy resulted in a diminished insulin response to oral glucose, which could have been due to vagal denervation of the pancreas or, more probably, impaired release of small-bowel hormones which normally augment the pancreatic insulin response.
Topics: Adult; Blood Glucose; Chronic Disease; Duodenal Ulcer; Female; Glucose; Glucose Tolerance Test; Humans; Insulin; Insulin Secretion; Male; Middle Aged; Pylorus; Vagotomy
PubMed: 1125698
DOI: 10.1136/bmj.2.5963.112 -
California Medicine Oct 1951Postoperative fistula occurred in 16 of 761 cases in which subtotal gastrectomy was done. Twelve of the 16 patients died. In the majority of cases complications arose...
Postoperative fistula occurred in 16 of 761 cases in which subtotal gastrectomy was done. Twelve of the 16 patients died. In the majority of cases complications arose because of the anatomical location of the ulcer with surrounding inflammation. Abrupt and dramatic onset of symptoms following leakage occurred in only a few cases. Perforation occurred in a few cases after the patient had been discharged home well and asymptomatic. Obstruction of the proximal limb was not present in any of the cases in which postmortem examination was carried out. The exclusion operation with resection of antral mucosa may not be a safe procedure. For treatment of ulcer which cannot be removed, gastroenterostomy with vagotomy is advised.
Topics: Digestive System Surgical Procedures; Female; Fistula; Gastrectomy; Gastroenterostomy; Humans; Male; Postoperative Complications; Stomach; Vagotomy
PubMed: 14879273
DOI: No ID Found -
Annals of Surgery Oct 1977A prospective, randomized study of proximal gastric vagotomy without drainage (PGV) was done in 174 adult men with chronic duodenal ulcer intractable to medical therapy.... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
A prospective, randomized study of proximal gastric vagotomy without drainage (PGV) was done in 174 adult men with chronic duodenal ulcer intractable to medical therapy. PGV was randomized against truncal vagotomy with antrectomy (TV + A) and against selective gastric vagotomy with Finney pyloroplasty (SGV + P). Postgastrectomy sequelae (dumping, diarrhea and reflux gastritis) were less after PGV. One patient after PGV developed a recurrent ulcer as did one patient after SGV + P. Two patients developed gastric ulcers after PGV. Good to excellent results (Visick I and II) were obtained in 96% of patients with PGV, 94% with TV + A and 86% with SGV + P. Follow-up studies were from six months to four years.
Topics: Adult; Aged; Duodenal Ulcer; Follow-Up Studies; Gastrectomy; Humans; Male; Middle Aged; Postgastrectomy Syndromes; Postoperative Complications; Pulmonary Embolism; Pyloric Antrum; Pyloric Stenosis; Pylorus; Recurrence; Stomach; Surgical Wound Infection; Vagotomy
PubMed: 907396
DOI: 10.1097/00000658-197710000-00013 -
British Medical Journal May 1959
Topics: Biomedical Research; Diarrhea; Humans; Stomach Diseases; Vagotomy
PubMed: 13638651
DOI: 10.1136/bmj.1.5130.1142 -
Annals of Surgery May 1993This article reviews the authors' experience with endoscopic management of duodenal ulcer and ulcers occurring after a previous drainage procedure.
OBJECTIVE
This article reviews the authors' experience with endoscopic management of duodenal ulcer and ulcers occurring after a previous drainage procedure.
SUMMARY BACKGROUND DATA
Patients with complications of duodenal ulcer and ulcers occurring after a previous drainage procedure still require surgical management. Virtually all operations for duodenal ulcer include some form of vagotomy. American surgeons in academic centers prefer highly selective vagotomy in suitable candidates. Video-directed laparoscopic and thoracoscopic operations have been done for all complications of duodenal ulcer except for acute hemorrhage.
METHODS
The authors have performed laparoscopic operation on eight patients with intractable chronic duodenal ulcer, seven patients with gastroesophageal reflux disease combined with duodenal ulcer, one patient with chronic duodenal ulcer and gastric outlet obstruction, and one patient with acute perforation. Operations performed included omentopexy, anterior seromyotomy plus post truncal vagotomy, and highly selective vagotomy. Seven patients had a simultaneous Nissen fundoplication; and the patient with obstruction underwent concomitant pyloroplasty and vagotomy. Six patients with intestinal ulcers occurring after a previous drainage procedure were treated with thoracoscopic vagotomy. Techniques used are shown.
RESULTS
There has been one recurrent ulcer in the laparoscopic group after anterior seromyotomy plus posterior truncal vagotomy. The patient treated by omentopexy for duodenal perforation recovered gastrointestinal function promptly with no further difficulty, but eventually died of primary medical disease. Patients undergoing thoracoscopic vagotomy have all become asymptomatic. Postoperative hospital stay after highly selective vagotomy, anterior seromyotomy plus posterior truncal vagotomy, or thoracoscopic vagotomy was 1-5 days.
CONCLUSIONS
Laparoscopic management of duodenal ulcers is feasible. Larger numbers of patients with longer follow-up are essential. Ulcers occurring after a drainage procedure deserve thoracoscopic vagotomy.
Topics: Adult; Aged; Chronic Disease; Duodenal Ulcer; Female; Gastric Outlet Obstruction; Gastroesophageal Reflux; Humans; Laparoscopy; Male; Middle Aged; Recurrence; Thoracoscopy; Treatment Outcome; Vagotomy
PubMed: 8489318
DOI: 10.1097/00000658-199305010-00016 -
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 -
American Journal of Physiology.... Aug 2005Mice, with the variety of genotypes they provide, should be particularly useful for studies of growth factors and gene products in regeneration of autonomic pathways...
Mice, with the variety of genotypes they provide, should be particularly useful for studies of growth factors and gene products in regeneration of autonomic pathways such as the vagus nerve. To provide a foundation for examinations of mouse vagal reorganization, two experiments assessed the rate, extent, and accuracy of afferent reinnervation of the stomach after vagotomy and related these patterns to feeding behavior. In experiment 1, the pattern of afferent regrowth into the gut after unilateral truncal vagotomy was characterized by labeling of these afferents with wheat germ agglutinin-horseradish peroxidase and Micro-Ruby. Regenerating neurites had reached and, in some cases, already reinnervated the stomach by 4 wk after axotomy. By 8 wk, regrowth was more extensive, and many fibers had redifferentiated terminals in the smooth muscle. By 16 wk, vagal projections had reached or exceeded normal density in the corpus, density in the forestomach was still reduced, and regrowth in the antrum was minimal. At all time points, not only appropriate terminals, but also growth cones and aberrant endings, were observed. In experiment 2, meal patterns of vagotomized mice were evaluated using a solid diet over the period of regeneration; cholecystokinin suppression of a liquid meal after unilateral and bilateral truncal vagotomies was also evaluated. Unilaterally, as well as bilaterally, vagotomized animals ate smaller and more frequent meals. These disturbed patterns became more pronounced in the first 8 wk after vagotomy, during regeneration. Cholecystokinin inhibition of intake was attenuated by bilateral, but not unilateral, vagotomy. Overall, the spatial and temporal patterns of structural and functional changes observed during regeneration verify that the mouse provides a useful preparation for examining the control of vagal plasticity.
Topics: Afferent Pathways; Animals; Feeding Behavior; Gastrointestinal Tract; Male; Mice; Mice, Inbred C57BL; Neuronal Plasticity; Regeneration; Vagotomy; Vagus Nerve
PubMed: 15831767
DOI: 10.1152/ajpregu.00167.2005 -
Annals of Surgery Apr 1982Vagotomy and gastric surgery have been implicated in gallstone formation, although the association remained unproven. Gallbladder function was investigated in 11...
Vagotomy and gastric surgery have been implicated in gallstone formation, although the association remained unproven. Gallbladder function was investigated in 11 patients with a pyloroplasty and truncal vagotomy, 5 with a subtotal gastrectomy, and 16 healthy controls. Gallbladder filing and emptying in response to cholecystokinin (CCK 0.01 U/kg min), when quantitated by 99m-Tc-HIDA cholescintigraphy, did not show any differences between the control and the surgical groups. In each group, over 70% of hepatic activity partitioned into the gallbladder rather than the duodenum, filing the gallbladder at 2.1%/min. Gallbladder emptying began five minutes after initiating the CCK infusion and ejected half of its contents during the next 12 minutes. Biliary lipid compositions was determined in 20 patients who underwent elective pyloroplasty and vagotomy for duodenal ulcer disease. Gallbladder bile collected at surgery was compared to bile-rich duodenal fluid aspirated eight months after recovery from surgery. Cholesterol saturation decreased significantly (p less than 0.05) both in terms of the relative cholesterol content (6.9% leads to 5.2%) and the lithogenic index (1.24 leads to 0.84). To determine if a selective increase in one of the conjugated bile salts could explain this improvement, bile salt composition was analyzed by high pressure liquid chromatography in eight patients and showed no change after surgery. Thus, vagotomy does not adversely affect gallbladder function, but instead improves cholesterol solubility.
Topics: Adolescent; Adult; Aged; Bile; Bile Acids and Salts; Cholelithiasis; Cholesterol; Female; Gallbladder; Gastrectomy; Humans; Male; Middle Aged; Peptic Ulcer; Phospholipids; Postoperative Complications; Vagotomy
PubMed: 7065746
DOI: 10.1097/00000658-198204000-00006 -
Annals of Surgery May 1979This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The results of parietal cell vagotomy without drainage (PCV) and selective vagotomy-antrectomy and Billroth I anastomosis (SV-A-B I) were compared. There was no mortality. Postoperatively patients were examined at two, six, 12 months and every 12 months thereafter. The two operations showed no statistical difference in the frequency of diarrhea. Dumping was less (p < .01) after PCV than after SV-A-B I. Weight loss was less (p < .01) after PCV than after SV-A-B I. There were no recurrent ulcers after SV-A-B I and five after PCV. In each instance but one the recurrent ulcer healed on withdrawal of an ulcerogenic drug. One patient required reoperation. Reoperations in the PCV group consisted of one for recurrent ulcer, one for gastric outlet obstruction and three for intestinal obstruction. The reoperations after SV-A-B I consisted of four for gastric outlet obstruction, three for intestinal obstruction, one for ruptured spleen and two for incisional hernia. PCV was technically feasible and practical to perform except in the occasional patient with severe pyloric stenosis. Obesity was never a deterrent. After PCV it is reasonable to assume that a recurrent ulcer rate in the range of 5-10% can be expected by surgeons who have been properly trained. This recurrence rate is higher than that after SV-A-B I but no higher than that encountered with TV-P. The recurrence rate is acceptable and is a fair exchange for the avoidance of dumping and weight loss that accompany SV-A-B I with significantly greater frequency and which on occasion can produce gastric crippling, although this did not occur in this study. All recurrent ulcers after PCV do not require reoperation but when operative treatment is required the patient has all the options that he had prior to PCV.
Topics: Body Weight; Diarrhea; Dumping Syndrome; Duodenal Ulcer; Gastric Juice; Humans; Methods; Postoperative Complications; Prospective Studies; Pyloric Antrum; Stomach; Stomach Diseases; Vagotomy
PubMed: 443916
DOI: 10.1097/00000658-197905000-00015 -
Gut Mar 1990
Review
Topics: Diarrhea; Humans; Postoperative Complications; Vagotomy
PubMed: 2182397
DOI: 10.1136/gut.31.3.245