A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease

Lagoo, Janaka; Pappas, Theodore N.; Perez, Alexander

doi:10.1016/j.amjsurg.2013.02.012

Cited by 79 publications

(58 citation statements)

References 37 publications

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“…We obtained information on whether vagotomies were truncal (including selective vagotomies requiring pyloroplasty) or superselective gastric procedures. 13 We used the Danish Civil Registration System to assemble a matched general population comparison cohort of individuals, who had not undergone vagotomy as of the surgery date of the corresponding patient (the index date). 15 We randomly selected up to 10 persons from the general population for each patient who underwent vagotomy, matched on year of birth, gender, and index date.…”

Section: Methodsmentioning

confidence: 99%

“…We excluded peptic ulcer from the CCI because it is the main indication for vagotomy and likely to be present in almost all patients undergoing this procedure. 13 We also collected DNPR data-in addition to the rheumatological diseases included in the CCI-on other arthritis/arthrosis diagnoses (yes/no) (see Supporting Appendix 1 for diagnosis codes).…”

Section: Possible Confoundersmentioning

confidence: 99%

“…10 Additionally, vagotomy has been shown to elimi-Vagotomy, a surgical procedure in which the vagus nerve is resected, was previously a common treatment for peptic ulcer. 13 Two primary types of vagotomy were performed: full truncal vagotomy, in which both vagal trunks were severed, and superselective vagotomy, in which only the nerves supplying the fundus and body of the stomach were resected. Thus, if the dual hit hypothesis is correct, truncal vagotomy would be expected to confer a protective effect on subsequent PD risk, whereas superselective vagotomy would be associated with a minor or no protective effect.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Vagotomy and subsequent risk of Parkinson's disease

Svensson

Horváth‐Puhó

Thomsen

et al. 2015

Annals of Neurology

678

439

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Section: Methodsmentioning

confidence: 99%

Section: Possible Confoundersmentioning

confidence: 99%

mentioning

confidence: 99%

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Vagotomy and subsequent risk of Parkinson's disease

Svensson

Horváth‐Puhó

Thomsen

et al. 2015

Annals of Neurology

678

439

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show abstract

“…There is a recent trend for surgical option for managing complicated peptic ulcer to shift from conventional vagotomy/drainage/gastrectomy to simple local suture or nonoperative endoscopic/angiographic hemostasis procedure. [12] With the notion that severance of hyperactive vagus nerve may have favorable action on serum glucose modulation and type 2 diabetes development, the present study was undertaken to assess the impact of vagotomy on the risk of developing diabetes in patients with peptic ulcer based on National Health Insurance database in Taiwan.…”

Section: Introductionmentioning

confidence: 99%

Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in peptic ulcer patients

Chen²,

Fang

et al. 2016

Medicine

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Vagus nerve may play a role in serum glucose modulation. The complicated peptic ulcer patients (with perforation or/and bleeding) who received surgical procedures with or without vagotomy provided 2 patient populations for studying the impact of vagus nerve integrity. We assessed the risk of developing type 2 diabetes in peptic ulcer patients without and with complications by surgical treatment received in a retrospective population study using the National Health Insurance database in Taiwan.A cohort of 163,385 patients with peptic ulcer and without Helicobacter pylori infection in 2000 to 2003 was established. A randomly selected cohort of 163,385 persons without peptic ulcer matched by age, sex, hypertension, hyperlipidemia, Charlson comorbidity index score, and index year was utilized for comparison. The risks of developing diabetes in both cohorts and in the complicated peptic ulcer patients who received truncal vagotomy or simple suture/hemostasis (SSH) were assessed at the end of 2011.The overall diabetes incidence was higher in patients with peptic ulcer than those without peptic ulcer (15.87 vs 12.60 per 1000 person-years) by an adjusted hazard ratio (aHR) of 1.43 (95% confidence interval [CI] = 1.40–1.47) based on the multivariable Cox proportional hazards regression analysis (competing risk). Comparing ulcer patients with truncal vagotomy and SSH or those without surgical treatment, the aHR was the lowest in the vagotomy group (0.48, 95% CI = 0.41–0.56).Peptic ulcer patients have an elevated risk of developing type 2 diabetes. Moreover, there were associations of vagus nerve severance and decreased risk of subsequent type 2 diabetes in complicated peptic ulcer patients.

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“…The functional changes and consequences of this type of injury have not been investigated or evaluated systematically and the clinical consequences remain unclear for that reason. Earlier studies reporting the effect of intended vagotomy on gastric ulcer disease show that vagotomy is accompanied by gastric stasis (nausea 15%, vomiting 4%), diarrhea (20-30%) and dumping syndrome (10%) [15,16,17,18,19]. Latrogenic or accidental VNI during ARS may have effects similar to those after intended vagotomy and therefore, may contribute to newly developed postoperative symptoms and to impaired reflux control after ARS.…”

Section: Introductionmentioning

confidence: 99%

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review

Rijn

Roebroek²,

Conchillo³

et al. 2016

Dig Surg

155

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Background: Vagus nerve injury (VNI) is a feared complication of antireflux surgery (ARS). The impact of VNI on the functional outcomes of ARS has not yet been evaluated systematically. The aim of this review was to evaluate the impact of VNI on functional and clinical outcome of ARS. Methods: A systematic search was performed until March 2015, using the following online databases: MEDLINE, Embase and the Cochrane Register of Controlled Clinical Trials. Eight studies remained available for assessment. Articles were divided into 2 groups: (a) one with unintended, accidental VNI and (b) one group comparing ARS with and without intended vagotomy. Results: The prevalence of unintended, accidental VNI ranged from 10 to 42% after ARS. No clear differences were seen in outcome for reflux control between the VNI and vagus nerve intact group. A higher prevalence of diarrhea, nausea and vomiting was observed in the VNI group. Conclusion: VNI is a feared but neglected complication of ARS. Larger prospective studies that objectively assess vagus nerve integrity before and after ARS are needed.

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A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease

Cited by 79 publications

References 37 publications

Vagotomy and subsequent risk of Parkinson's disease

Vagotomy and subsequent risk of Parkinson's disease

Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in peptic ulcer patients

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review

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