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| Intervention: Vagotomy |
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| Course and distribution of the glossopharyngeal, vagus, and accessory nerves. | ||
| ICD-10 code: | ||
| ICD-9 code: | 44.0 | |
| MeSH | D014628 | |
| Other codes: | ||
A vagotomy is a surgical procedure that is performed only in humans. It is resection (removal of, or at least severing) of part of the vagus nerve. It is not to be confused with vasectomy.
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For weight loss
The use of vagotomy to treat obesity is being studied[1][2]. Early results show an average of 18% weight loss[3]. Vagotomy may have an impact upon ghrelin.[4]
For ulcers
The operation was popular up until the mid-1990s as a way of treating peptic ulcer disease, and preventing its recurrence. It was (incorrectly) thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the peptic cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of gastro-esophageal reflux in those who suffered from it.
The incidence of vagotomy decreased following the discovery by Barry Marshall and Robin Warren that Helicobacter pylori is responsible for most peptic ulcers. The first-line treatment for peptic ulcer disease, if due to H. pylori, is "triple therapy": 2 antibiotics (clarithromycin and amoxicillin or metronidazole) and a proton pump inhibitor (e.g. omeprazole). However, in chronic ulceration or in gastric outlet obstruction there is still an important role for truncal vagotomy.
Types
A plain vagotomy is a very destructive procedure, since all the parasympathetic supply from the stomach to the left side of the transverse colon relies on the vagus nerves. The gut will still function without vagus supply, but not as well.
Vagotomy technique was therefore improved by restricting resection to only those branches that go to the stomach (selective vagotomy),[5] and further by selecting only those branches that appear to supply peptic cells (highly selective vagotomy).
Humans have two vagus nerves, whose fibres decussate and intermingle around the stomach. Accordingly, a vagotomy operates on both nerves simultaneously and in practice there is no need or way to make a distinction between them.
References
- ^ "Could nerve-snipping spur weight loss? - USATODAY.com".
- ^ "VCU Surgical Weight Loss Center".
- ^ Research into 20 minute nerve cutting procedure results in average 18% weight loss
- ^ Williams DL, Grill HJ, Cummings DE, Kaplan JM (December 2003). "Vagotomy dissociates short- and long-term controls of circulating ghrelin". Endocrinology 144 (12): 5184–7. doi:. PMID 14525914.
- ^ Jordan PH, Thornby J (September 1994). "Twenty years after parietal cell vagotomy or selective vagotomy antrectomy for treatment of duodenal ulcer. Final report". Ann. Surg. 220 (3): 283–93; discussion 293–6. PMID 8092897.
External links
- MeSH Vagotomy
- 00934 at CHORUS
- Overview and illustrations at surgeryencyclopedia.com
- Four types, at endoscopy-sages.com
- Overview at healthatoz.com
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Wikipedia content modification information:
- This page was last modified on 13 September 2008, at 21:20.
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