Are bloodflow changes after selective proximal vagotomy responsible for a necrosis in the gastric wall?

Abstract

Animal experiments were performed to investigate bloodflow distribution before and after selective vagotomy to explain gastric mucosa necrosis found in some patients after vogtomy. Flow measurements were made using the microsphere technique. Changes in the microcirculation were determined under basal and stimulated conditions (250 mg 2-desoxy-D-glucose). After selective vagotomy a reduction in bloodflow of up to 50% could be observed in all layers of the stomach. There were no differences in the bloodflow along either the lesser or greater curvature under basal conditions. In the stimulated stomach, however, the increase in bloodflow along the lesser curvature was higher, although the vessels of this region were mostly altered by SPV operative procedure. From these results it can be concluded that a reducton of arterial input after selective proximal vagotomy is probably compensated for by intramucosal or submucosal anastomoses. Therefore, necrosis in the gastric wall is not due to SPV but probably to other accompanying diseases.

Gastric necrosis and perforation as a complication of splenectomy. Case report and related references

“…Surgical procedures on the stomach itself or lower esophagus may also provoke gastric necrosis. The pathogenesis of ischemic necrosis of the small curvature after proximal gastric vagotomy is explained by the relative blood deficiency characteristic of this region, associated with the reduction in mucous blood flow consequent to the vagotomy (15,16,21) . Concomitant splenectomy may further aggravate this risk due to the additional blood deprivation it causes (1,10,20) due to ligation of the short vessels and occasionally the left gastric omental artery or the posterior gastric artery when present.…”

Effect of proximal gastric vagotomy on human gastric blood flow evaluated by endoscopic laser doppler flowmetry

“…The results in this study are consistent with the findings in other studies. Investigations in animals using K 85 and 99m Tc clearance techniques, and the microsphere technique have demonstrated flow reductions in the stomach amounting to 50% after truncal vagotomy and PGV [3,15,16]. Intraoperative measurements with LDF before and after PGV have shown similar results along the devascularized part of the lesser curvature [17].…”

“…The effect of partial devascularization of the stomach on the gastric blood flow has been investigated during experimental conditions in animals [3,4]. Laser Doppler flowmetry (LDF) is a method which has been proven capable of reflecting changes in the gastric blood flow in animals, and in a previous study we have shown that it is a practical means of studying gastric circulation endoscopically in conscious man [5][6][7].…”

Die Magenwandnekrose nach selektiv-proximaler Vagotomie

“…Auch im Tierexperiment konnte durch SPV eine 50~oige Flowminderung nachgewiesen werden; allerdings erzielte hier vagale Stimulation eine generelle Flowsteigerung [22], so da6 die -Klinikern seit langem bekannte -hervorragende Collateralisierung der Magenwandgef'~iBe im Regelfall den Ausfall der A. gastrica sinistra zu kompensieren vermag. Die MWN nach SP V setzt somit eine Collateralgefgiflinsuffizienz voraus [22], was auch den Ergebnissen des ,,klinischen Massenversuchs SPV" entspricht.…”