Method of Testing for Complete Nerve Section During Vagotomy

Abstract

MARCH 15, 1958 RESULTS OF VAGOTOMY AND GASTRO-ENTEROSTOMY MEDIC1LJRNAL 615 reduced to a figLure as low as, or lower than, the best after gastrectomy.We at one time thought that the incidence of changed bowel habit after vagal-nerve section might wveigh in favour of gastrectomy. However, a study of these symptoms after gastrectomy reveals exactly the same problem, although to a somewhat less degree. In trying to assess the place of vagotomy and gastroenterostomy, we do not believe that it is indicated only in certain types of patient, as, for example, in women and elderly men. If it is to be used at all, then in our view it should be used in all cases where surgery is necessary. In the present state of our knowledge, based on this eight-year study, we believe that. given complete nerve-trunk section, vagotomy and gastro-enterostomy is the operation of choice. At one time we thought that a surgeon experienced in this operation could in every case achieve complete nerve-trunk section without the use of a test. Since such a test has been available we have satisfied ourselves that this is not true and that even an experienced surgeon will obtain better results with this help.It will be interesting, in the future, to study the late results of this operation in cases in which complete nerve-trunk section has been proved at operation. Summary 301 cases, of which only 6 are untraced, of duodenal ulceration treated by vagotomy and gastro-enterostomy are reported. All patients have been followed up for at least seven years. The proved recurrence rate was 4.25%, and this in spite of evidence of a high rate of incomplete nerve section. There has been no proved recurrence in this series since an earlier review in 1955.The results of this operation are compared with those of gastrectomy, and it is concluded that vagotomy and gastro-enterostomy is a better operation so long as there is no great increase in the recurrence rate as shown by a long-term study. From The method described here was devised to allow the surgeon to test the completeness of vagotomy before the abdomen was closed. It consists in the application of a simple physiological technique to the human and, as such, was first validated on cats. It has now been applied successfully to patients, and is both safe and reliable. MethodCats.-Cats were anaesthetized with chloralose (80 mg./ kg.). The blood pressure was recorded on a kymograph with a mercury manometer connected to a cannula in the left carotid artery. The intragastric pressure was also recorded on the kymograph, using a water manometer connected through the system, as shown in Fig. 1, to give a better exposure of the lower oesophagus. A largebore cuffed rubber tube was passed by the mouth until its

The selective nerve stain leucomethylene blue as an intraoperative aid to achieving complete vagotomy

“…Burge's electrical stimulation test (Burge and Vane, 1958;Burge, Roberts, Stedeford, and Lancaster, 1969) has not met with general acceptance because it is inconvenient and of questionable reliability (Lythgoe, 1961;Clark and Murray, 1963). Lee's new method appeared to offer an attractive alternative.…”

The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man

“…If a proximal gastric vagotomy was selected, the operation was concluded by confirming that the vagal nerve supply to the antrum was intact. Modified electrodes from a Burge vagotomy stimulator (Burge and Vane, 1958) were applied to the main vagal trunks at the hiatus and stimulation resulted in visible antral contractions (atropine abolishes this response and is avoided in premedication). If a selective vagotomy was selected the left gastric bundle, including the nerves of Latarjet (Latarjet, Cluzet, and Wertheimer, 1921), was divided close to the antrum.…”

Vagotomie und Vagotomiekontrolle ?Ergebnisse einer Umfrage

“…Wesentlich ffir den Erfolg der Vagotomie ist die Volls~ndigkeit der Nervendurchtrennung. Ausgehend von den Schwierigkeiten der intraoperativen Beurteilung des Ausmal]es der Vagotomie, wurden mehrere Verfahren zur Vagotomiekontrolle entwickelt [2,5,9,16], deren Wert allerdings wiederholt in Frage gestellt wurde.…”