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A STUDY OF VAGOTOMY

A STUDY OF VAGOTOMY Abstract SINCE the report by Dragstedt1 of 2 patients on whom he performed transthoracic section of the vagus nerves for duodenal ulcer, much interest and investigation have centered on the role of the vagus nerves in gastrointestinal physiology and on their relation to peptic ulcer. The earliest recorded experiments on the vagus nerves and their effect on the gastrointestinal tract were made in 1814 by Brodie,2 who observed changes in gastric secretion following division of the vagus nerves in the cervical region in dogs. Hartzell,3 in his review published in 1929, traced the progress in the understanding of vagus nerve function to the time of Brodie's publication. In 1910 Pavlov4 demonstrated that intact vagus innervation was necessary for the psychic or cephalic phase of gastric secretion and, through these studies, stimulated the investigation of gastrointestinal physiology. Vagus section in gastrointestinal surgery was apparently first undertaken by Exner References 1. Dragstedt, L. R., and Owens, F. M., Jr: Supra-Diaphragmatic Section of the Vagus Nerves in Treatment of Duodenal Ulcer , Proc. Soc. Exper. Biol. & Med. 53:152, 1943. 2. Brodie, B., cited by Hartzell. 3. Hartzell, J. B.: The Effect of Section of the Vagus Nerves on Gastric Acidity , Am. J. Physiol. 91:162, 1929. 4. Pavlov, I. P.: The Work of the Digestive Glands , (translated by W. H. Thompson), C. Griffin & Company, London, 1910. 5. Exner, A.: Ein neues Operationsverfahren bei tabischen Crises gastriques , Deutsch. Ztsch. f. Chir. 111:576, 1911. 6. (a) Bircher, E.: Die Resektion von Aesten der N. vagus zur Behandlung gastrischer Affektionen , Schweiz. med. Wchnschr. 50:519, 1920. 7. (b) Latarjet, A.: Resection des nerfs de l'estomac , Bull. Acad. de med., Paris 87:681, 1922. 8. (c) Schiassi, B.: The Role of the Pyloro-Duodenal Nerve Supply in the Surgery of Duodenal Ulcer , Ann. Surg. 81:939, 1925. 9. Carlson, A. J.: Secretion of Gastric Juice in Health and Disease , Physiol. Rev. 3:1, 1923. 10. Schiffrin, M. J., and Ivy, A. C.: Physiology of Gastric Secretion , Arch. Surg. 44:399 ( (March) ) 1942. 11. Winkelstein, A.: Studies in Gastric Secretion , Am. J. Surg. 15:523, 1932 12. One Hundred and Sixty-Nine Studies in Gastric Secretion During the Night , Am. J. Digest. Dis. 1:778, 1935 13. The Medical Treatment of Peptic Ulcer Refractory to Sippy Treatment , Surgery 17:699, 1945. 14. Thorton, T. F.; Storer, E. H., and Dragstedt, L. R.: Supradiaphragmatic Section of Vagus Nerves in Patients with Peptic Ulcer , Proc. Soc. Exper. Biol. & Med. 59:140, 1945. 15. Alley, A.: The Secretory Activity of the Gastric Mucosa in the Region of the Lesser Curvature , Tr. Roy. Soc. Canada 27:71, 1933. 16. Jeremin, E. E.; Hollander, F., and Weinstein, V. A.: A Comparison of Insulin and Food as Stimuli for the Differentiation of Vagal and Non-Vagal Pouches , Gastroenterology 1:500, 1943. 17. Hollander, F.: Insulin Test for Presence of Intact Nerve Fibers , Gastroenterology 7:607, 1946. 18. Vanzant, F. R.: The Late Restoration of Gastric Acidity after Thoracic Vagotomy in the Dog , Gastroenterology 8:768, 1947. 19. Dragstedt, L. R.; Woodward, E. R.; Harper, P. V., and Storer, E. H.: Mechanism of the Relief of Ulcer Distress by Gastric Vagotomy , Gastroenterology 10:200, 1948. 20. Wolf, S., and Andrus, W. DeW.: The Effect of Vagotomy on Gastric Function , Gastroenterology 8:429, 1947. 21. McCrea, E. D.; McSwiney, B. A., and Stopford, J. S. B.: Effect on the Stomach of Section of the Vagi , Quart. J. Exper. Physiol. 16:195, 1926. 22. Postlethwait, R. W.; Hill, H. V., Jr.; Chittum, J. R., and Grimson, K. S.: Effect of Vagotomy and of Drugs on Gastric Motility , Ann. Surg. 128:184, 1948. 23. Grimson, K. S.; Baylin, G. J.; Taylor, H. M.; Hesser, F. W., and Rundles, R. W.: Transthoracic Vagotomy , J. A. M. A. 134:925 ( (July 12) ) 1947.Crossref 24. Berg., B. N.: Peptic Ulcer , Arch. Surg. 28:1057 ( (June) ) 1934.Crossref 25. Kapsinow, R.: The Experimental Production of Duodenal Ulcer by Exclusion of Bile for the Intestine , Ann. Surg. 83:614, 1926.Crossref 26. Bickel, A.: Beobachtungen an Hunden mit extirpierten Duodenum , Klin. Wchnschr. 46:1201, 1909. 27. Grey, E. G.: Duodenectomy: Its Effect upon the Life of an Animal , Surg., Gynec. & Obst. 28:36, 1919. 28. Mann, F. C., and Kawamura, K.: Duodenectomy , Ann. Surg. 75:208, 1922. 29. Dragstedt, L. R.: Some Physiological Principles Involved in the Surgical Treatment of Gastric and Duodenal Ulcer , Ann. Surg. 102:563, 1935. 30. Matthews, W. B., and Dragstedt, L. R.: The Etiology of Gastric and Duodenal Ulcer , Surg. Gynec. & Obst. 55:265, 1932. 31. Hay, L. J.; Varco, R. L.; Code, C. F., and Wangensteen, O. H.: The Experimental Production of Gastric and Duodenal Ulcer in Laboratory Animals by the Intra-Muscular Injection of Histamine in Beeswax, , Surg. Gynec. & Obst. 75:170, 1942. 32. Ophuls, W.: Gastric Ulcers in Rabbits Following Resection of the Pneumogastric Nerves Below the Diaphragm , J. Exper. Med. 8:181, 1906. 33. Mann, F. C., and Beaver, M. G.: The Production of Peptic Ulcer after Section of the Gastric Nerve , Ann. Surg. 94:1116, 1931. 34. Greggio, E.: Des ulceres gastroduodenaux , Arch. de. med. exper. et d'anat. path. 27:533, 1916. 35. Ferguson, J. H.: Effects of Vagotomy on the Gastric Functions of Monkeys , Surg., Gynec. & Obst. 62:689, 1936. 36. Mann, F. C., and Williamson, C. S.: The Experimental Production of Peptic Ulcer , Ann. Surg. 77:409, 1923. 37. Harkins, H. N.; Hooker, D. H.; Alford, T. C.; Callender, J.; Elliott, S. R.; Kearns, W.; Mitchener, J., and Cooley, D.: Symposium on Vagotomy for Peptic Ulcer: I. Experimental Observations , Bull. Johns Hopkins Hosp. 81:79, 1947. 38. Oliver, J. V.: Effect of Vagotomy on the Development of the Mann-Williamson Ulcer in the Dog , Arch. Surg. 55:180 ( (Aug.) ) 1947. 39. Dragstedt, L. R.: Vagotomy and the Mann-Williamson Ulcer, editorial , Surg., Gynec. & Obst. 87:749, 1948. 40. Johns, T. N. P., and Grose, W. E.: Symposium on Vagotomy for Peptic Ulcer: II. Early Surgical Results in Forty-Three Cases , Bull. Johns Hopkins Hosp. 81:92, 1947. 41. Ritvo, M., and Schauffer, I. A.: Roentgenographic Studies of the Gastro-Intestinal Tract Following Section of Vagus Nerves for Peptic Ulcer , New England J. Med. 238:496, 1948. 42. Cannon, W. B.: The Mechanical Factors of Digestion , London, Edward Arnold & Company, 1911. 43. Bayliss, and Starling: J. Physiol. 26:114, 1900 44. Weeks, D. M.: Observations of Small and Large Bowel Motility in Man , Gastroenterology 6:185, 1946. 45. Starling: Ergebn. d. Physiol. 1:460, 1902Crossref 46. Alvarez, W. C.: The Mechanics of the Digestive Tract , New York, Paul B. Hoeber, Inc., 1929. 47. Wells, J. A.; Mercer, T. H.; Grey, J. S., and Ivy, A. C.: Motor Innervation of the Colon , Am. J. Physiol. 138:83, 1942. 48. Meltzer and Auer: Proc. Soc. Exper. Biol. & Med. 4:39, 1907 49. Machella, T. E.; Hodges, H. H., and Lorber, S. H.: The Restoration of Gastric Motility by Urethane of B-Methylcholine after Section of the Vagus Nerves for Peptic Ulcer , Gastroenterology 8:36, 1947. 50. Goodman, L., and Gilman, A.: The Pharmacological Basis of Therapeutics , New York, The Macmillan Company, 1941. 51. Miller, E. M., and Olwin, J. H.: Results of Resection of the Vagus Nerve for Chronic Peptic Ulcer , Arch. Surg. 57:353 ( (Sept.) ) 1948. 52. Dragstedt, L. R., in discussion on Colp, R.; Klingenstein, P.; Druckerman, L. J., and Weinstein, V. A.: A Comparative Study of Subtotal Gastrectomy With and Without Vagotomy , Ann. Surg. 128:476, 1948. 53. Moore, F. D.: Vagus Resection for Ulcer: An Interim Evaluation , Ann. Surg. 126:664, 1947. 54. Walters, W., in discussion on Dragstedt, Harper, Tovee and Woodward,49 p. 707. 55. McCrea, E. D.: Abdominal Distribution of the Vagus , J. Anat. 59:18, 1924. 56. Dragstedt, L. R.; Fournier, H. J.; Woodward, E. R.; Tovee, E. B., and Harper, P. V.: Transabdominal Gastric Vagotomy , Surg., Gynec. & Obst. 85:461, 1947. 57. Doubilet, H.; Shafiroff, B. G. P., and Mulholland, J. A.: The Anatomy of the Peri-Esophageal Vagi , Ann. Surg. 127:128, 1948. 58. Bradley, W. F.; Small, J. T.; Wilson, J. W., and Walters, W.: Anatomic Consideration of Gastric Neurectomy , J. A. M. A. 133:459 ( (Feb. 15) ) 1947. 59. Miller, E. M., and Davis, C. B., Jr.: An Anatomic Study of the Vagus Nerves , J. A. M. A. 133:461 ( (Feb. 15) ) 1947. 60. Jackson, R. G.: Anatomic Study of the Vagus Nerves , Arch. Surg. 57:333 ( (Sept.) ) 1948. 61. Beal, J. M.: Diaphragmatic Hernia Following Subdiaphragmatic Vagotomy , Surgery 24:625, 1948. 62. Wilcox, R. S.: To be published. 63. Dragstedt, L. R., in discussion on Dragstedt; Harper; Tovee and Woodward , Ann. Surg. 126:708, 1947. 64. Mettler, F. A.: Neuroanatomy , St. Louis, C. V. Mosby Company, 1942. 65. Cooper, W. A.: Personal communication to the authors. 66. Cooper, W. A.: End Results in the Treatment of Peptic Ulcer by Posterior Gastroenterostomy , Surgery 23:425, 1948. 67. Allen, A. W., and Welch, C. E.: Gastric Ulcer: Significance of This Diagnosis and Its Relationship to Cancer , Ann. Surg. 114:498, 1941. 68. Marshall, S. F., and Welch, M. L.: Results of Surgical Treatment for Gastric Ulcer , J. A. M. A. 136:748 ( (March 13) ) 1948. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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American Medical Association
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Copyright © 1950 American Medical Association. All Rights Reserved.
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0004-0010
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1538-3644
DOI
10.1001/archsurg.1950.01250010221001
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Abstract

Abstract SINCE the report by Dragstedt1 of 2 patients on whom he performed transthoracic section of the vagus nerves for duodenal ulcer, much interest and investigation have centered on the role of the vagus nerves in gastrointestinal physiology and on their relation to peptic ulcer. The earliest recorded experiments on the vagus nerves and their effect on the gastrointestinal tract were made in 1814 by Brodie,2 who observed changes in gastric secretion following division of the vagus nerves in the cervical region in dogs. Hartzell,3 in his review published in 1929, traced the progress in the understanding of vagus nerve function to the time of Brodie's publication. In 1910 Pavlov4 demonstrated that intact vagus innervation was necessary for the psychic or cephalic phase of gastric secretion and, through these studies, stimulated the investigation of gastrointestinal physiology. Vagus section in gastrointestinal surgery was apparently first undertaken by Exner References 1. Dragstedt, L. R., and Owens, F. M., Jr: Supra-Diaphragmatic Section of the Vagus Nerves in Treatment of Duodenal Ulcer , Proc. Soc. Exper. Biol. & Med. 53:152, 1943. 2. Brodie, B., cited by Hartzell. 3. Hartzell, J. B.: The Effect of Section of the Vagus Nerves on Gastric Acidity , Am. J. Physiol. 91:162, 1929. 4. Pavlov, I. P.: The Work of the Digestive Glands , (translated by W. H. Thompson), C. Griffin & Company, London, 1910. 5. Exner, A.: Ein neues Operationsverfahren bei tabischen Crises gastriques , Deutsch. Ztsch. f. Chir. 111:576, 1911. 6. (a) Bircher, E.: Die Resektion von Aesten der N. vagus zur Behandlung gastrischer Affektionen , Schweiz. med. Wchnschr. 50:519, 1920. 7. (b) Latarjet, A.: Resection des nerfs de l'estomac , Bull. Acad. de med., Paris 87:681, 1922. 8. (c) Schiassi, B.: The Role of the Pyloro-Duodenal Nerve Supply in the Surgery of Duodenal Ulcer , Ann. Surg. 81:939, 1925. 9. Carlson, A. J.: Secretion of Gastric Juice in Health and Disease , Physiol. Rev. 3:1, 1923. 10. Schiffrin, M. J., and Ivy, A. C.: Physiology of Gastric Secretion , Arch. Surg. 44:399 ( (March) ) 1942. 11. Winkelstein, A.: Studies in Gastric Secretion , Am. J. Surg. 15:523, 1932 12. One Hundred and Sixty-Nine Studies in Gastric Secretion During the Night , Am. J. Digest. Dis. 1:778, 1935 13. The Medical Treatment of Peptic Ulcer Refractory to Sippy Treatment , Surgery 17:699, 1945. 14. Thorton, T. F.; Storer, E. H., and Dragstedt, L. R.: Supradiaphragmatic Section of Vagus Nerves in Patients with Peptic Ulcer , Proc. Soc. Exper. Biol. & Med. 59:140, 1945. 15. Alley, A.: The Secretory Activity of the Gastric Mucosa in the Region of the Lesser Curvature , Tr. Roy. Soc. Canada 27:71, 1933. 16. Jeremin, E. E.; Hollander, F., and Weinstein, V. A.: A Comparison of Insulin and Food as Stimuli for the Differentiation of Vagal and Non-Vagal Pouches , Gastroenterology 1:500, 1943. 17. Hollander, F.: Insulin Test for Presence of Intact Nerve Fibers , Gastroenterology 7:607, 1946. 18. Vanzant, F. R.: The Late Restoration of Gastric Acidity after Thoracic Vagotomy in the Dog , Gastroenterology 8:768, 1947. 19. Dragstedt, L. R.; Woodward, E. R.; Harper, P. V., and Storer, E. H.: Mechanism of the Relief of Ulcer Distress by Gastric Vagotomy , Gastroenterology 10:200, 1948. 20. Wolf, S., and Andrus, W. DeW.: The Effect of Vagotomy on Gastric Function , Gastroenterology 8:429, 1947. 21. McCrea, E. D.; McSwiney, B. A., and Stopford, J. S. B.: Effect on the Stomach of Section of the Vagi , Quart. J. Exper. Physiol. 16:195, 1926. 22. Postlethwait, R. W.; Hill, H. V., Jr.; Chittum, J. R., and Grimson, K. S.: Effect of Vagotomy and of Drugs on Gastric Motility , Ann. Surg. 128:184, 1948. 23. Grimson, K. S.; Baylin, G. J.; Taylor, H. M.; Hesser, F. W., and Rundles, R. W.: Transthoracic Vagotomy , J. A. M. A. 134:925 ( (July 12) ) 1947.Crossref 24. Berg., B. N.: Peptic Ulcer , Arch. Surg. 28:1057 ( (June) ) 1934.Crossref 25. Kapsinow, R.: The Experimental Production of Duodenal Ulcer by Exclusion of Bile for the Intestine , Ann. Surg. 83:614, 1926.Crossref 26. Bickel, A.: Beobachtungen an Hunden mit extirpierten Duodenum , Klin. Wchnschr. 46:1201, 1909. 27. Grey, E. G.: Duodenectomy: Its Effect upon the Life of an Animal , Surg., Gynec. & Obst. 28:36, 1919. 28. Mann, F. C., and Kawamura, K.: Duodenectomy , Ann. Surg. 75:208, 1922. 29. Dragstedt, L. R.: Some Physiological Principles Involved in the Surgical Treatment of Gastric and Duodenal Ulcer , Ann. Surg. 102:563, 1935. 30. Matthews, W. B., and Dragstedt, L. R.: The Etiology of Gastric and Duodenal Ulcer , Surg. Gynec. & Obst. 55:265, 1932. 31. Hay, L. J.; Varco, R. L.; Code, C. F., and Wangensteen, O. H.: The Experimental Production of Gastric and Duodenal Ulcer in Laboratory Animals by the Intra-Muscular Injection of Histamine in Beeswax, , Surg. Gynec. & Obst. 75:170, 1942. 32. Ophuls, W.: Gastric Ulcers in Rabbits Following Resection of the Pneumogastric Nerves Below the Diaphragm , J. Exper. Med. 8:181, 1906. 33. Mann, F. C., and Beaver, M. G.: The Production of Peptic Ulcer after Section of the Gastric Nerve , Ann. Surg. 94:1116, 1931. 34. Greggio, E.: Des ulceres gastroduodenaux , Arch. de. med. exper. et d'anat. path. 27:533, 1916. 35. Ferguson, J. H.: Effects of Vagotomy on the Gastric Functions of Monkeys , Surg., Gynec. & Obst. 62:689, 1936. 36. Mann, F. C., and Williamson, C. S.: The Experimental Production of Peptic Ulcer , Ann. Surg. 77:409, 1923. 37. Harkins, H. N.; Hooker, D. H.; Alford, T. C.; Callender, J.; Elliott, S. R.; Kearns, W.; Mitchener, J., and Cooley, D.: Symposium on Vagotomy for Peptic Ulcer: I. Experimental Observations , Bull. Johns Hopkins Hosp. 81:79, 1947. 38. Oliver, J. V.: Effect of Vagotomy on the Development of the Mann-Williamson Ulcer in the Dog , Arch. Surg. 55:180 ( (Aug.) ) 1947. 39. Dragstedt, L. R.: Vagotomy and the Mann-Williamson Ulcer, editorial , Surg., Gynec. & Obst. 87:749, 1948. 40. Johns, T. N. P., and Grose, W. E.: Symposium on Vagotomy for Peptic Ulcer: II. Early Surgical Results in Forty-Three Cases , Bull. Johns Hopkins Hosp. 81:92, 1947. 41. Ritvo, M., and Schauffer, I. A.: Roentgenographic Studies of the Gastro-Intestinal Tract Following Section of Vagus Nerves for Peptic Ulcer , New England J. Med. 238:496, 1948. 42. Cannon, W. B.: The Mechanical Factors of Digestion , London, Edward Arnold & Company, 1911. 43. Bayliss, and Starling: J. Physiol. 26:114, 1900 44. Weeks, D. M.: Observations of Small and Large Bowel Motility in Man , Gastroenterology 6:185, 1946. 45. Starling: Ergebn. d. Physiol. 1:460, 1902Crossref 46. Alvarez, W. C.: The Mechanics of the Digestive Tract , New York, Paul B. Hoeber, Inc., 1929. 47. Wells, J. A.; Mercer, T. H.; Grey, J. S., and Ivy, A. C.: Motor Innervation of the Colon , Am. J. Physiol. 138:83, 1942. 48. Meltzer and Auer: Proc. Soc. Exper. Biol. & Med. 4:39, 1907 49. Machella, T. E.; Hodges, H. H., and Lorber, S. H.: The Restoration of Gastric Motility by Urethane of B-Methylcholine after Section of the Vagus Nerves for Peptic Ulcer , Gastroenterology 8:36, 1947. 50. Goodman, L., and Gilman, A.: The Pharmacological Basis of Therapeutics , New York, The Macmillan Company, 1941. 51. Miller, E. M., and Olwin, J. H.: Results of Resection of the Vagus Nerve for Chronic Peptic Ulcer , Arch. Surg. 57:353 ( (Sept.) ) 1948. 52. Dragstedt, L. R., in discussion on Colp, R.; Klingenstein, P.; Druckerman, L. J., and Weinstein, V. A.: A Comparative Study of Subtotal Gastrectomy With and Without Vagotomy , Ann. Surg. 128:476, 1948. 53. Moore, F. D.: Vagus Resection for Ulcer: An Interim Evaluation , Ann. Surg. 126:664, 1947. 54. Walters, W., in discussion on Dragstedt, Harper, Tovee and Woodward,49 p. 707. 55. McCrea, E. D.: Abdominal Distribution of the Vagus , J. Anat. 59:18, 1924. 56. Dragstedt, L. R.; Fournier, H. J.; Woodward, E. R.; Tovee, E. B., and Harper, P. V.: Transabdominal Gastric Vagotomy , Surg., Gynec. & Obst. 85:461, 1947. 57. Doubilet, H.; Shafiroff, B. G. P., and Mulholland, J. A.: The Anatomy of the Peri-Esophageal Vagi , Ann. Surg. 127:128, 1948. 58. Bradley, W. F.; Small, J. T.; Wilson, J. W., and Walters, W.: Anatomic Consideration of Gastric Neurectomy , J. A. M. A. 133:459 ( (Feb. 15) ) 1947. 59. Miller, E. M., and Davis, C. B., Jr.: An Anatomic Study of the Vagus Nerves , J. A. M. A. 133:461 ( (Feb. 15) ) 1947. 60. Jackson, R. G.: Anatomic Study of the Vagus Nerves , Arch. Surg. 57:333 ( (Sept.) ) 1948. 61. Beal, J. M.: Diaphragmatic Hernia Following Subdiaphragmatic Vagotomy , Surgery 24:625, 1948. 62. Wilcox, R. S.: To be published. 63. Dragstedt, L. R., in discussion on Dragstedt; Harper; Tovee and Woodward , Ann. Surg. 126:708, 1947. 64. Mettler, F. A.: Neuroanatomy , St. Louis, C. V. Mosby Company, 1942. 65. Cooper, W. A.: Personal communication to the authors. 66. Cooper, W. A.: End Results in the Treatment of Peptic Ulcer by Posterior Gastroenterostomy , Surgery 23:425, 1948. 67. Allen, A. W., and Welch, C. E.: Gastric Ulcer: Significance of This Diagnosis and Its Relationship to Cancer , Ann. Surg. 114:498, 1941. 68. Marshall, S. F., and Welch, M. L.: Results of Surgical Treatment for Gastric Ulcer , J. A. M. A. 136:748 ( (March 13) ) 1948.

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1950

References