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Where is your vagotomy incomplete? Observations on operative technique

Where is your vagotomy incomplete? Observations on operative technique There is a trend in gastric surgery towards more selective types of vagotomy but the techniques are more difficult and incomplete nerve section may be more likely. Using the Grassi intra-operative test of mucosal pH, we have studied 50 consecutive patients, 13 having truncal vagotomy, 9 having bilateral selective vagotomy and 28 having proximal gastric vagotomy. We have identified four distinct areas of the stomach where nerve fibres are likely to be left. Three of these can usually be eliminated by careful attention to technique, but the fourth—the distal extent of the parietal cell mass—can only be identified by a precise intra-operative test; this is relevant to proximal gastric vagotomy but not to truncal vagotomy. Unexpected anatomical variations of the vagus nerve branches were found in 8 patients. A precise intra-operative test of residual innervation is particularly helpful in establishing the technique of proximal gastric vagotomy. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png British Journal of Surgery Oxford University Press

Where is your vagotomy incomplete? Observations on operative technique

Johnson, A G; Baxter, H K
British Journal of Surgery , Volume 64 (8): 4 – Aug 1, 1977
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References (12)

Publisher
Oxford University Press
Copyright
Copyright © 1977 British Journal of Surgery Society Ltd.
ISSN
0007-1323
eISSN
1365-2168
DOI
10.1002/bjs.1800640816
Publisher site
See Article on Publisher Site

Abstract

There is a trend in gastric surgery towards more selective types of vagotomy but the techniques are more difficult and incomplete nerve section may be more likely. Using the Grassi intra-operative test of mucosal pH, we have studied 50 consecutive patients, 13 having truncal vagotomy, 9 having bilateral selective vagotomy and 28 having proximal gastric vagotomy. We have identified four distinct areas of the stomach where nerve fibres are likely to be left. Three of these can usually be eliminated by careful attention to technique, but the fourth—the distal extent of the parietal cell mass—can only be identified by a precise intra-operative test; this is relevant to proximal gastric vagotomy but not to truncal vagotomy. Unexpected anatomical variations of the vagus nerve branches were found in 8 patients. A precise intra-operative test of residual innervation is particularly helpful in establishing the technique of proximal gastric vagotomy.

Journal

British Journal of Surgery – Oxford University Press

Published: Aug 1, 1977

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