TY  - CHAP
M1  - Book, Section
TI  - VAGOTOMY
A1  - Ellison, E. Christopher
A1  - Zollinger, Robert M.
PY  - 2016
T2  - Zollinger's Atlas of Surgical Operations, 10e
AB  - Bilateral  resection  of  segments  of  the  vagus  nerves  in  the  region  of  the  lower  esophagus  is  a  key  component  in  treating  intractable  duodenal  or  gastrojejunal  ulcers,  refractory  to  antisecretory  medicine  or  when  intervening  situation  is  not  optimized.  The  motor  paralysis  and  resultant  gastric  retention  that  may  follow  truncal  vagotomy  alone  make  it  mandatory  that  a  concomitant  gastric  resection  or  drainage  procedure,  such  as  pyloroplasty  or  an  antrally  placed  gastroenterostomy,  be  performed.  Gastrojejunal  or  stomal  ulcers  following  a  previous  gastrectomy  or  gastrojejunostomy  show  a  favorable  response  to  vagotomy.  The  use  of  vagotomy  to  control  the  cephalic  phase  of  secretion  is  preferred  when  it  is  desirable  to  retain  as  much  gastric  capacity  as  possible  because  of  the  preoperative  nutritional  status  of  the  patient  with  duodenal  ulcer.  In  those  individuals  below  their  ideal  weight  preoperatively,  controlling  the  acid  factor  by  vagotomy  followed  by  pyloroplasty,  posterior  gastroenterostomy,  or  hemigastrectomy  should  be  seriously  considered.  In  many  patients  laparoscopy  provides  excellent  exposure  of  the  vagal  trunks  and  mobilization  of  the  distal  esophagus  can  be  straightforward.  In  patients  with  scarring  or  previous  operation  consideration  could  be  given  to  a  transthoracic  thoracoscopic  approach  via  the  left  chest  to  the  GE  junction.  There  are  two  vagal  trunks—the  anterior  or  left  vagus  nerve,  which  lies  along  the  anterior  wall  of  the  esophagus,  and  the  posterior  or  right  vagus  nerve,  which  is  sometimes  overlooked  since  it  is  more  easily  separated  from  the  esophagus.  The  vagus  nerves  may  be  divided  5  to  7  cm  above  the  esophageal  junction  (truncal  vagotomy),  divided  below  the  celiac  and  hepatic  branches  (selective  vagotomy),  or  divided  so  that  only  the  branches  to  the  upper  two-thirds  of  the  stomach  are  interrupted,  while  the  nerves  of  Latarjet,  innervating  the  antrum  or  lower  one-third,  as  well  as  the  celiac  and  hepatic  branches,  are  retained  (proximal  gastric  vagotomy).  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1127271921
ER  -