- Alexander Perez, MD, FACS
Alexander Perez, MD, FACS
- Professor and Division Chief
- Department of Surgery
- University of Texas Medical Branch
- Galveston, Texas
- Section Editors
- David I Soybel, MD
David I Soybel, MD
- Editor-in-Chief — General Surgery
- Section Editor — Upper GI Surgery
- David L. Nahrwold Professor
- Penn State Hershey Medical Center
- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease; Nutrition, Malabsorption, and Misc. Upper GI Disease
- Professor of Medicine
- Harvard Medical School
The vagus nerves play a central role in regulating gastric acid production. Therefore, the disruption of vagal innervation has long been exploited as an antisecretory measure. The surgical technique of vagotomy has a rich history dating back nearly a century . At its peak application, vagotomy performed in conjunction with either pyloroplasty or antrectomy was once the gold standard for the treatment of peptic ulcer disease. The following decades saw the development of histamine H2-receptor antagonists and proton pump inhibitors, along with the discovery of the role Helicobacter pylori plays in peptic ulcer disease . The success of these modern nonsurgical therapies reduced the incidence of ulcer-related complications requiring surgical interventions. When surgical interventions are required, technological advances have allowed vagotomy to be performed with minimally invasive techniques with fewer procedure-related complications .
The use of vagotomy in treating complicated peptic ulcer disease and the technical aspects of performing vagotomy will be reviewed here. Other considerations of peptic ulcer disease management are discussed elsewhere. (See "Surgical management of peptic ulcer disease" and "Peptic ulcer disease: Management".)
Vagotomy is indicated for patients who develop acute complications from peptic ulcer disease (ie, bleeding, perforation, obstruction) or chronic intractable symptoms such as pain, despite being on maximally tolerated medical therapies. Vagotomy is rarely performed as a "stand-alone" procedure except for treatment of chronic duodenal ulcers. It is generally performed in conjunction with a stomach drainage, resection, or diversion procedure to treat complicated peptic ulcer disease .
While the primary procedure is chosen to treat the complication, vagotomy is typically added to prevent ulcer recurrence, especially in patients who are refractory to or intolerant of maximal medical therapy. An increasingly popular view is that the primary goal is for surgery to treat the complication while causing as little trauma as possible. Medical treatment is then instituted to treat the underlying cause of the peptic ulcer disease.
The efficacy of vagotomy is difficult to measure separately from the primary procedure, and the outcomes of patients undergoing peptic ulcer disease surgery depend mostly on the success of the primary procedures. (See "Surgical management of peptic ulcer disease".)
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