Selective Proximal Vagotomy Research Articles

Need for pyloroplasty and vagotomy in case of perforated duodenal ulcer

Aim. Estimation of the incidence of stenosis, need for pyloroplasty and validity of vagotomy for perforated duodenal ulcer (PDU).
 Materials and methods. Twenty-year nature of surgical treatment of patients with PDC in the hospital surgery clinic is analyzed.
 Results. Over 20 years, 726 patients were operated on: 151 women (20.8%), 575 men (79.2%), mean age 39.1±6.3 years. Surgeries were performed both from laparotomic access and video laparoscopically. It is found that PDU is combined with stenosis in 8.5% and with bleeding in 1.6%, which requires Jadd excision of an ulcer on the anterior wall or gastroduodenotomy for flashing a bleeding ulcer on the posterior wall (0.7%) with subsequent Heineke — Mikulicz pyloroplasty and vagotomy. Both stem vagotomy and selective proximal were used by the method of skeletonization of lesser curvature or chemoneurolysis. Suturing with selective proximal vagotomy was performed in 567 patients, isolated suturing — in 77. B-II distal gastric resection was required in 2.1%. Repeated admission of patients with complications of a duodenal ulcer is observed after isolated suturing of PDU without surgical intervention in the mechanisms of ulcer formation.
 Conclusion. During surgical treatment of PDU are found in 79.2% of men, in 20.8% of women. There is an emerging stenosis in 8.5% of those who have PDU, which requires a gastric drainage operation. The subjects of choice may be Heineke-Mikulicz pyloroplasty or Jadd excision of an ulcer on the anterior wall. It is advisable to suture or excise an ulcer with pyloroplasty accompanied by vagotomy that normalizes the acid-proteolytic activity of gastric juice in the postoperative period and eliminates need for antisecretory drugs to prevent the recurrence of the disease.

Functional gastrostasis in patients with duodenal stenosis after duodenoplasty and selective proximal vagotomy

Functional gastrostasis in patients with duodenal stenosis after duodenoplasty and selective proximal vagotomy

Analysis of Recent Cases of Postbulbar Duodenal Ulcer in Japan

Although the incidence of postbulbar duodenal ulcers is low, many complications occur, such as hemorrhage, stenosis and perforation, and there are many points to be paid attention to with regard to its pathology. A high acid level has been pointed out as a cause, but this is not conclusive, and its association with Helicobacter pylori (Hp) infection is also unclear. We investigated chronic cases excluding acute cases such as acute duodenal mucosal lesion we encountered between 2001 and 2015. Five cases corresponded, accounting for 1.4% of all chronic duodenal ulcer cases, and there were more male patients (four patients were male), as previously reported. All cases were solitary punched-out ulcer on the medial side near the superior duodenal flexure, and many complications were observed such as melena in all patients, narrowing in 2, and penetration in 1. No specific pathology, such as Crohn’s disease, vasculitis, or Zollinger-Ellison syndrome, was noted, no patient was previously medicated with NSAIDs or low dose aspirin, and 3 patients were infected with Hp. All cases were healed by proton pump inhibitor administration or gastric acid secretion-suppressing treatment with selective proximal vagotomy. Recurrence after Hp eradication occurred in all of the 3 Hp-infected patients, suggesting that involvement of Hp in the cause of disease is unlikely.

COMPREHENSIVE TREATMENT DECOMPENSATED DUODENAL PEPTIC STENOSIS

Purpose: comparative evaluation of surgical methods of treatment of decompensated cicatricial-ulcerative stenosis of the duodenum and rationale for the choice of optimal tactics in complex treatment of these patients. Materials and Methods: summarizes the experience of complex treatment of 112 patients with decompensated cicatricialulcerative stenosis of the duodenum. 82 patients underwent radical duodenoplasty, aimed at restoring the motor-evacuation and secretory functions of the stomach, selective proximal vagotomy. 30 patients underwent resection of 2/3 of the stomach in various modifications. Results: The highest number of complications in the main group account for those patients who were simultaneously performed duodenoplasty and SPV. With the transition to a two-step method of surgical treatment postoperative complications almost never met. Almost all the pathological conditions in the long-term period after surgery is more pronounced in patients who underwent resection of the stomach. Summary: adical duodenoplasty allows to demonstrate the possibility of full recovery of gastric function after radical removal of pathological substrate and the preservation of the pylorus.

The electrophysiological characteristics of the motor activity of the gastrointestinal tract following selective proximal vagotomy in the patients presenting with ulcerative pyloroduodenal stenosis

The electrophysiological characteristics of the motor activity of the gastrointestinal tract following selective proximal vagotomy in the patients presenting with ulcerative pyloroduodenal stenosis

腹腔鏡補助下選択的近位迷走神経切離術が奏効した十二指腸潰瘍再発の１例

腹腔鏡補助下選択的近位迷走神経切離術が奏効した十二指腸潰瘍再発の１例

Multiple Early Carcinomas of the Esophagus Associated with Achalasia Treated by Endoscopic Submucosal Dissection

We report a case of early esophageal carcinomas associated with achalasia treated by endoscopic submucosal dissection. A 46-year-old man was diagnosed of esophageal achalasia, flask type and Grade II in 2001, and had been treated by pneumatic dilatation for symptomatic achalasia conservatively. The patient was operated by Tokai University method, Heller's long esophagomyectomy, Hill's posterior cardiopexy, fundoplication and selective proximal vagotomy using a laparotomy in August 2009. One year and three months after the operation, two lesions of early carcinomas of type 0-IIb and 0-IIc, each 1cm in size, were detected in the middle thoracic esophagus, and treated by endoscopic submucosal dissection. Pathological examination of the each lesion revealed proliferation of squamous cell carcinoma in situ (T1a-EP). The entire esophageal mucosa around the carcinoma demonstrated hyperplastic changes of stratified squamous epithelium and foci of intraepithelial neoplasia. In the patient of achalasia, food stasis in esophagus is thought to induce chronic hyperplastic esophagitis, converting eventually to malignant transformation. Achalasia is known as a risk factor of esophageal squamous cell carcinoma. Careful long-term follow-up for patients of achalasia by endoscopic screening is recommended, even if after treatment by pneumatic dilatation or operation for achalasia.

ОСОБЛИВОСТІ РЕМОДЕЛЮВАННЯ СТРУКТУР СЛИЗОВОЇ ОБОЛОНКИ ШЛУНКА ПІСЛЯ РІЗНИХ МЕТОДІВ ХІРУРГІЧНОГО ЛІКУВАННЯ ВИРАЗКОВОЇ ХВОРОБИ ШЛУНКА У ВІДДАЛЕНОМУ ПЕРІОДІ

<p>A morphometric study of operated stomach walls after different methods of surgical treatment of gastric ulcer was performed. It was shown that in the remote period operated stomach wall structure had a tendency to regenerate. The most optimal changes were detected after organsparing method of surgical treatment – selective proximal vagotomy with sighting resection of ischemic segment of the stomach by L. Ya. Kovalchuk.</p>

The comparative valuation of effectiveness of different variants of stomach resection and vagotomy made on the background of portal hypertension in experiment

There were used 85 dogs in 65 series of testing during experiment with the aim of comparison in studying the infl uence of stomach resection according to Billrot I and II on the portal pressure and blood speed in the portal vein; on the background of modeling portal hypertension there were investigated the optimal variants of stomach resection and vagotomy. According to the observation of animals condition, their vascular, functional and morphologic data there were found out that the stomach resection according to Billrot I and II without dependence on methodics didn't infl uence on the pressure and blood speed in portal vein; more rational intervention on the background of portal hypertension would be stomach resection with the preservation of unity of gastro-omental vessels and their anastomosis between themselves with parietal mobilization; among organ-saving operations – selective proximal vagotomy.

Asymptomatic free intraperitoneal gas with duodenal stenosis.

A 30-year-old man was referred to our hospital in October 2006 for asymptomatic free air in the peritoneal cavity found on a plain chest X-ray on a routine health examination. Esophagogastroduodenoscopy (EGD) revealed an ulcer scar and deformity of the duodenal bulb, a healing-phase ulcer in the anterior wall of the upper gastric corpus, gradeB esophagitis (Los Angeles grading system), and a sliding hiatal hernia. A test for Helicobacter pylori was negative. Upon obtaining an informed consent (asymptomatic perforation), laparoscopic selective proximal vagotomy, Toupet fundoplication, and small skin incision Finney pyloroplasty were performed. Intraoperatively, extensive adhesions of the greater omentum to the duodenal bulb were found, which were suspected to engulf the cryptic perforation. The patient's postoperative course has been uneventful and, at present, recurrence of the ulcer has not been observed. The presented case is rare considering the absence of surgical history, lack of symptoms, and incidental finding of the intraperitoneal free air during a health examination.

Results of surgical rehabilitation of the top parts of the gastroenteric canal in patients with duodenogastroesophageal reflux

Are presented results of clinical use of an original way of strengthening antireflux function pyloric sphincter at patients expressed duodenogastroesophageal reflux. The expediency of performance of surgical rehabilitation esophagogastroduodenal canal, including selective proximal vagotomy, correction chronic duodenal obstruction, strengthening antireflux functions of the gatekeeper and formation the mechanism cardium therefore optimum anatomo-physiological conditions for normalization of processes of digestion are created is proved.

Small Bowel Obstruction Produced by a Phytobezoar

A 68-year-old man was admitted to the hospital with a history of daily vomiting and weight loss of 8 kg within 3 weeks. The patient had undergone a selective proximal vagotomy with pyloroplasty for a bleeding duodenal ulcer (1981) and a Billroth I reconstruction with distal gastrectomy for a perforated NSAID-induced gastric ulcer (1999). Laboratory data revealed leukocytosis of 15,400/mm3 (range, 4,200–10,200), with 88% neutrophils (range, 42%–69%) and a modest increase of the C- reactive protein, 7 mg/L (range, <5).

The selective proximal vagotomy by the method of chemical denervation in the treatment of patients with perforating pyloroduodenal ulcers

The selective proximal vagotomy by the method of chemical denervation in the treatment of patients with perforating pyloroduodenal ulcers

A comparison of gastric emptying at 3 and 12 months after proximal gastric or selective vagotomy without pyloroplasty.

Abstract A prospective study was performed to determine whether the early postoperative disturbance of gastric emptying after vagotomy altered with the passage of time. In 20 patients the rate of emptying of a 10 per cent dextrose meal was measured by a double sampling dye dilution technique before and 3 months after proximal gastric vagotomy or selective vagotomy without a drainage procedure. Ten of these patients agreed to a further emptying study at 12 months after operation. Profound changes in the pattern of emptying occurred as a result of either operation. At 3 months after operation both selective and proximal gastric vagotomy were associated with an initial cascading of part of the meal (gastric incontinence). Selective vagotomy was then associated with an increase in the time taken for complete emptying, whereas after proximal gastric vagotomy the time taken for complete emptying was similar to that before surgery. In the next 9 months after operation no significant change occurred in the initial cascading, but the delay in complete emptying after selective vagotomy improved in some patients.

Acid-fundic selective vagotomy of the stomach without drainage in the treatment of duodenal ulcer: technique and results.

Abstract Out of 415 patients with duodenal ulcer under-going vagotomy in the past 6 years, 198 truncal vagotomies (T.V.) and 217 selective vagotomies (S.V.) were performed. Of the 217 S. V. s, 134 cases had a total selective vagotomy of the stomach (preserving the pyloroduodenal nervous peduncle), and in 83 cases a proximal selective vagotomy was performed (preserving also the antral branches of the two principal nerves of the gastric lesser curve or Latarjet nerves). The authors prefer the name ‘acid-fundic selective vagotomy (A.F.S.V.) of the stomach’ for the latter procedure. In 89 of the patients having S.V. no gastric drainage procedure was performed; in 27 of these a total S.V. had been performed and in 62 cases an A.F.S.V. In patients undergoing S.V. without gastric drainage the clinical results and gastric emptying were fairly good in the cases with a total S.V. (follow-up time, 12 months), and very good in the cases with an A.F.S.V. (follow-up time, 6 months). Basal acid output (B.A.O.) and maximal (pentagastrin-stimulated) acid output (M.A.O.) were evaluated in those patients undergoing A.F.S.V. before and 10 days after operation. B.A.O. was reduced by 80.5 per cent and M.A.O. by 68.5 per cent. An insulin test performed 3 months after operation was negative in 80 per cent of cases (complete vagotomy); in the other cases the vagotomy was adequate. Clinical results, although after only a short follow-up, suggest that the procedure can be considered as the treatment of choice in most patients with an uncomplicated duodenal ulcer (76 per cent in our series). Gastric drainage is required only in cases of stenosing duodenal ulcer with delayed gastric emptying. Pyloroplasty is also mandatory in the treatment of bleeding ulcer and of perforated ulcer (if the suture is stenosing).

Postalimentäre Hypoglykämien bei Spätdumping-Syndrom

A 48-year-old patient had been suffering from postalimentary hypoglycemias for several months, occurring regularly 2 hours after a meal. 5 years before, repeated fundaplications as well as a selective proximal vagotomy due to reflux oesophagitis had been performed. Physical examination revealed no pathological findings. The diurnal blood sugar profile with hourly capillary glucose measurement showed a physiological fasting glucose homeostasis and two-hour postprandial decrease of blood glucose down to 20 mg/dl. The oral glucose tolerance test revealed a noticeable insulin secretion with a pathologically increased insulin/glucose index. Scintigraphy demonstrated an initially delayed, then accelerated gastric emptying as a consequence of the selective proximal vagotomy. A postalimentary hypoglycemia by hypersecretion of insulin in the context of a post-gastrectomy late dumping syndrome was diagnosed. A surgical pyloroplasty was not effective. In addition to the modification of eating habits, treatment with subcutaneous applied octreotide (Sandostatin), a somatostatin-analogue, was initiated. Postalimentary hypoglycemia can be assigned to late dumping syndrome in most cases already by ascribed history taking. The correct diagnosis can be achieved by an oral glucose tolerance test with measurement of insulin secretion and gastric emptying scintigraphy. Beside other therapeutical options the treatment with octreotide is a promising alternative with manageable side effects.

選択的近位迷走神経切離術施行後１７年目に発症した前庭部胃癌の１例

症例は59歳,男性. 1982年,十二指腸潰瘍のためSPVと胃十二指腸吻合術を受けた.しかし,術後も胸やけや悪心を繰り返すため, 1998年11月30日胃内視鏡検査を受けた.胃十二指腸吻合部の口側粘膜に陥凹性病変を認め,生検にてGroup Vと診断されたため同年12月8日当科に紹介された.精査で前庭部早期胃癌と診断し,同年12月21日手術を施行した.触診上腫瘍の局在は明らかでなく,胃切開による粘膜観察を要した.肉眼的にもIIc型早期胃癌であったため,幽門側胃切除術(D1+No.7)およびBillroth-II法による再建を行った.術後診断はT1, N0, M0, Stage I Aであり,病理組織学的には深達度smであった. 本邦における迷走神経切離術後患者の胃癌発生率は約0.12%であり,長期経過した症例では発症期待値が高いため,特に厳重な経過観察を要する.

GASTRIC CANCER OCCURRED 22 YEARS AFTER SELECTIVE PROXIMAL VAGOTOMY-A CASE REPORT-

The patient was 59-year-old man. He had a selective proximal vagotomy with pylorectomy and a reconstruction of gastrojejunostomy for duodenal ulcer 22 years ago. Nov. 1998 he visited our clinic because of epigastric pain and received gastric fiberscopy to be diagnosed as the gastric cancer that was located just oral to the anastomosis site of the stomach and the jejunum. Gastrectomy was performed safely. Gastric cancer following vagotomy is a rare entity and there have been only 22 cases in the Japanese literature. In our institution, vagotomy has been performed in a series of 395 patients from 1972 to 1999, and this patient was the third case that experienced gastric cancer after vagotomy. We present this third case with a review of the literature in terms of the correlation between vagotomy and development of gastric cancer.

Investigation of effect of lesser curvature seromyotomy of the stomach in animal experiments

The effectiveness of seromyotomy of the lesser curvature of the stomach--the simplified version of proximal selective vagotomy--was investigated in eleven dogs. Decreased acid secretion was proved with congo red test and pH measuring by glass electrode. No significant damage to the motor function of the stomach was found with scintigraphy. Histological examinations revealed neurofibre degeneration peripherally to the seromyotomy line after peripheral vagotomy and vacuolar degeneration in the ganglion cells and amputation neuromas in the seromyotomy line.

Gastric Bypass Distal Roux-en-Y Jejunal Interposition with Selective Proximal Vagotomy and Posterior Truncal Vagotomy.

Selective proximal vagotomy and posterior truncal vagotomy have been performed in 71 consecutive gastric bypass (GBP) patients from June 1991 to December 1992. Vagotomy was used to prevent or diminish the incidence of marginal ulcer in GBP patients. Anterior and posterior highly selective proximal vagotomy with circular-instrument stapled gastrojejunostomy in patients undergoing GBP distal Roux-en-Y with jejunal interposition had no marginal ulcer complications (minimal follow-up 18 months).