Truncal Vagotomy

A vagotomy is performed when acid production in the stomach can not be reduced by other means. The purpose of the procedure is to disable the acid-producing capacity of the stomach. It is used when ulcers in the stomach and duodenum do not respond to medication and changes in diet.

Before surgery, the stomach and gastrointestinal tract are visualized with gastroscopy and x-ray procedures, and standard preoperative blood and urine tests are done.

The procedure is performed using general anesthesia. Depending on the preference of the surgeon, the procedure can be performed using a flexible, lighted scope (laparoscope) or through a large abdominal incision. Tubes to drain the stomach (nasogastric tube) and the bladder (urinary catheter) are normally inserted. The surgeon makes a cut in the abdomen between the rib cage and the lower abdomen (over the stomach). The surgeon situates the vagus nerves, and clamps and cuts specific branches, depending on which procedure is being done.

Truncal vagotomy involves cutting segments of the two vagus nerve branches located where the esophagus joins the stomach. This procedure stops vagus nerve supply to the small intestine, gallbladder, liver, pancreas, bile ducts, stomach, and half of the large intestine. Since the flow to the stomach is affected, a pyloroplasty or another gastric drainage procedure usually accompanies truncal vagotomy.

Patients who have had a vagotomy stay in the hospital for about seven days. Nasogastric suctioning is required for the first three or four days. A tube is inserted through the nose and into the stomach. The stomach contents are then suctioned out. Patients eat a clear liquid diet until the gastrointestinal tract regains function. When patients return to a regular diet, spicy and acidic foods should be avoided.

It takes about six weeks to fully recover from the surgery. The sutures that close the skin can be removed in seven to 10 days. Patients are encouraged to move around soon after the operation to prevent the formation of deep vein blood clots. Pain medication, stool softeners, and antibiotics may be prescribed following the operation.

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