-
Gut Jul 1987Little is known of the temporal and quantitative relationships between emptying of the stomach and of the gall bladder in patients with duodenal ulcer before and after...
Little is known of the temporal and quantitative relationships between emptying of the stomach and of the gall bladder in patients with duodenal ulcer before and after vagotomy. A non-invasive double isotope technique was used to investigate these relationships in 27 patients with a duodenal ulcer, before and after operation-truncal vagotomy and pyloroplasty (TV + P; n = 15) and highly selective vagotomy (HSV; n = 12). A further 25 patients were studied after operation (TV + P, n = 20: HSV, n = 5). 99Tcm-EHIDA was used as the biliary tracer and 113Inm bran as the gastric content tracer. In patients with a duodenal ulcer before surgery and in 16 of the 17 patients studied after HSV, the patterns of gall bladder emptying were similar to those previously found in normal subjects. In 60% of patients after TV + P, patterns of gall bladder emptying were altered and the onset of gall bladder emptying was significantly delayed (p less than 0.001) compared with unoperated patients and patients with a HSV. The rate of gall bladder emptying did not correlate with the rate of gastric emptying in any of the patients studied. These observations suggest that TV + P, but not HSV, causes considerable alteration in coordination of gall bladder and gastric emptying.
Topics: Duodenal Ulcer; Food; Gallbladder; Gastric Emptying; Humans; Pylorus; Time Factors; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 3653754
DOI: 10.1136/gut.28.7.855 -
The American Journal of Gastroenterology May 1995We describe a case of gastroparesis after laparoscopic highly selective anterior and posterior truncal vagotomy in a 30-yr-old male with gastric ulcer disease. Motility... (Review)
Review
We describe a case of gastroparesis after laparoscopic highly selective anterior and posterior truncal vagotomy in a 30-yr-old male with gastric ulcer disease. Motility studies confirmed the diagnosis, and a pancreatic polypeptide sham feeding study suggested that a complete vagotomy may have been inadvertently performed. The experience with this procedure in gastric ulcer disease is extremely limited; review of the literature of laparoscopic highly selective vagotomy describes only two cases with delayed gastric emptying as defined by radiological examination. In view of the paucity of reports, caution is warranted, and this procedure should be undertaken only in the setting of a controlled trial.
Topics: Adult; Gastric Emptying; Gastroparesis; Humans; Laparoscopy; Male; Stomach Ulcer; Vagotomy, Proximal Gastric; Vagotomy, Truncal
PubMed: 7733092
DOI: No ID Found -
Annals of Surgery Mar 1983The relative merits of proximal gastric vagotomy (PGV), truncal vagotomy with drainage (TV + D), and truncal vagotomy with antrectomy (TV + A) in the treatment of... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The relative merits of proximal gastric vagotomy (PGV), truncal vagotomy with drainage (TV + D), and truncal vagotomy with antrectomy (TV + A) in the treatment of chronic duodenal ulcer were evaluated and compared in 152 patients in a prospective, randomized and controlled clinical trial. One death occurred after TV + A, resulting in an operative mortality of 2% after gastrectomy and 0.7% for the entire series. After one to six years, stomal and duodenal ulcers proven by endoscopy occurred in eight patients after PGV (16%) and in six patients after TV + D (11.8%); the difference was not statistically significant (p greater than 0.5). One additional patient developed a gastric ulcer nine months after PGV. There was so far no ulcer recurrence after TV + A. Majority (13 patients) of the recurrent ulcers were discovered within three years after surgery. Patients after PGV experienced significantly less unwanted side effects than those after either TV + D or TV + A; particularly, dumping, epigastric fullness, and diarrhea. When the functional status was graded according to a modified Visick system that excluded ulcer recurrence, significantly more PGV patients were placed in the near-perfect grade (82.1%) than TV + A patients (58%). Patients after TV + D fared better than patients after TV + A; but the differences were not significant. However, when ulcer recurrence was included in the functional assessment, the advantage of PGV was lost.
Topics: Chronic Disease; Clinical Trials as Topic; Drainage; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Pyloric Antrum; Random Allocation; Recurrence; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6338842
DOI: 10.1097/00000658-198303000-00004 -
Gut Dec 1971Six hundred and seventy-six insulin tests performed in the early postoperative period after vagotomy and drainage for duodenal ulcer were analysed by the criteria of...
Six hundred and seventy-six insulin tests performed in the early postoperative period after vagotomy and drainage for duodenal ulcer were analysed by the criteria of Hollander. Consultants had done 364 vagotomies, of which 17.6% were shown to be incomplete. Registrars and senior registrars had done 312, of which 12.2% were incomplete. Thus, consultants may not be significantly better, on average, than their juniors at achieving complete gastric vagotomy, even when allowance is made for the fact that they tend to take on the more difficult cases. The ability to achieve a complete vagotomy varied widely from surgeon to surgeon, regardless of his status. Of 515 truncal vagotomies, 15.7% were incomplete compared with 14.3% of 161 bilateral selective vagotomies. An ;early-positive' secretory response within one hour of the insulin injection, which is commonly regarded as indicating inadequate vagotomy, was found in 5.6% of patients after truncal vagotomy and 3.1% of patients after selective vagotomy.
Topics: Drainage; Duodenal Ulcer; Gastric Juice; Humans; Insulin; Methods; Surgical Procedures, Operative; Vagotomy
PubMed: 5157134
DOI: 10.1136/gut.12.12.963 -
Journal of Applied Physiology... Jan 2019Parasympathetic efferent innervation of the lung is the primary source of lung acetylcholine. Inhaled long-acting anticholinergics improve lung function and symptoms in...
Parasympathetic efferent innervation of the lung is the primary source of lung acetylcholine. Inhaled long-acting anticholinergics improve lung function and symptoms in patients with chronic obstructive pulmonary disease. Targeted lung denervation (TLD), a bronchoscopic procedure intended to disrupt pulmonary parasympathetic inputs, is an experimental treatment for chronic obstructive pulmonary disease. The physiologic and histologic effects of TLD have not previously been assessed. Eleven sheep and two dogs underwent circumferential ablation of the main bronchi with simultaneous balloon surface cooling using a lung denervation system (Nuvaira, Inc., Minneapolis, MN). Changes in pulmonary air flow resistance were monitored before and following TLD. Four animals were assessed for the presence or abolishment of the sensory axon-mediated Hering-Breuer reflex before and following TLD. Six sheep were histologically evaluated 30 days post-TLD for the extent of lung denervation (axonal staining) and effect on peribronchial structures near the treatment site. No adverse clinical effects were seen in any treated animals. TLD produced a ~30% reduction in pulmonary resistance and abolished the sensory-mediated Hering-Breuer reflex. Axonal staining was consistently decreased 60% at 30 days after TLD. All treated airways exhibited 100% epithelial integrity. Damage to other peribronchial structures was minimal. Tissue 1 cm proximal and distal to the treatment was normal, and the esophagus and periesophageal vagus nerve branches were unaffected. TLD treatment effectively denervates the lung while protecting the bronchial epithelium and minimizing effects on peribronchial structures. NEW & NOTEWORTHY The feasibility of targeted lung denervation, a new minimally invasive therapy for obstructive lung disease, has been demonstrated in humans with preliminary clinical studies demonstrating improvement in symptoms, pulmonary function, and exercise capacity in patients with chronic obstructive pulmonary disease. This preclinical animal study demonstrates the ability of targeted lung denervation to disrupt vagal inputs to the lung and details its physiologic and histopathologic effects.
Topics: Airway Resistance; Animals; Bronchoscopy; Dogs; Lung; Radiofrequency Ablation; Sheep; Vagotomy; Vagus Nerve
PubMed: 30359539
DOI: 10.1152/japplphysiol.00565.2018 -
British Medical Journal Feb 1972
Topics: Duodenal Ulcer; Electric Stimulation; Humans; Methods; Secondary Prevention; Stomach; Vagotomy
PubMed: 5008074
DOI: 10.1136/bmj.1.5798.510-b -
British Medical Journal Nov 1967
Topics: Blood Group Antigens; Duodenal Ulcer; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications; Vagotomy
PubMed: 6053620
DOI: 10.1136/bmj.4.5575.339 -
British Medical Journal Mar 1966
Topics: Abdomen; Cholecystectomy; Humans; Neurilemmoma; Postoperative Complications; Vagotomy
PubMed: 5909479
DOI: No ID Found -
Gut Sep 1974
Topics: Animals; Diarrhea; Dogs; Dumping Syndrome; Gastric Juice; Gastrins; Gastrointestinal Motility; Humans; Insulin; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Postoperative Complications; Pylorus; Rabbits; Recurrence; Secretory Rate; Stomach; Vagotomy
PubMed: 4435591
DOI: 10.1136/gut.15.9.748 -
Annals of Surgery Sep 1963
Topics: Animals; Dogs; Gallbladder; Haplorhini; Pancreas; Physiology; Research; Stomach; Vagotomy
PubMed: 14061711
DOI: 10.1097/00000658-196309000-00013