Indications for Parietal Cell Vagotomy Without Drainage in Gastrointestinal Surgery

Abstract

Parietal cell vagotomy (PCV) was used for a variety of gastrointestinal conditions in 658 patients. Operative and late related deaths after PCV were 1.1% (3/273) in patients with intractable duodenal ulcers, 1.1% (1/91) in perforated ulcers, 0% (0/43) in Type I gastric ulcers, 0% (0/45) in pyloric and prepyloric ulcers, 3.2% (6/188) when combined with fundoplication, 8.7% (2/23) when combined with vascular surgery, and 4.2% (1/24) in ulcer patients with acute bleeding. The recurrent ulcer rate after PCV was 8.4% in patients operated on for duodenal ulcer, 6.4% for perforated ulcer, 5.3% for bleeding ulcers, 10% for Type I gastric ulcers, and 31% for pyloric and prepyloric ulcers. PCV was preferred to total gastrectomy in four patients in whom a gastrinoma could not be located. PCV was used in 188 patients with reflux esophagitis and in 12 patients with achalasia to facilitate fundoplication and placement of the myotomy, respectively. Based on the results of the study, PCV is contraindicated in patients with pyloric and prepyloric ulcers. PCV is not recommended when traumatic dilatation of the pylorus is required to overcome obstruction. PCV may have limited application in patients with bleeding ulcers and Type I gastric ulcers. In our experience PCV is not contraindicated in patients with ulcers resistant to H2 receptor antagonists. PCV may be contraindicated when acid hypersecretion exceeds an as-yet undetermined level. PCV is an ideal procedure for intractable duodenal ulcers and perforated ulcers.

Vagotomy During Hiatal Hernia Repair: A Benign Esophageal Lengthening Procedure

“…9 Vagotomy, performed in the past mostly for peptic ulcer disease, has been associated with significant side effects and, thus, has not been considered by most surgeons as an option to lengthen the short esophagus. [10][11] It has been our policy to pay specific attention to the integrity of the vagi at the end of an operation on the hiatus. When one of the nerves was divided, usually during the repair of a large paraesophageal hernia or during a redo procedure, we took special note of it.…”

Billroth-I-Hemigastrektomie beim komplizierten Ulkusrezidiv nach selektiv proximaler Vagotomie

“…Ffir die kumulative Rezidivrate werden in der Literatur Prozents/itze zwischen 3 und 18 % nach 4 bis 12 Jahren angegeben [4,5,8,9]. Generell liegt die Reoperationsquote beim symptomatischen Rezidivulkus zwischen 8 und 40% [14,22,26]. Mit einer Ulkusblutung manifestieren sich 2,5-14% der Rezidive nach SPV, die Rate der Perforationen liegt bei 1,5-3,0% [10,13,18].…”

“…Das Intervall zwischen Ersteingriff und Rezidiv lag bei unseren Patienten im unteren Bereich (im Mittel 2,8 Jahre) der in der Literatur angegebenen Vergleichsdaten (3 bis 6 Jahre [1,8,14]). Bei Studien mit einem langen Beobachtungszeitraum wurden vereinzelt noch nach 10 bzw.…”