Selective Vagotomy

Burge, Harold

doi:10.1016/s0140-6736(64)91604-6

Cited by 9 publications

(11 citation statements)

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“…These authors seem to have disproved the contention of Bruce, Card, Marks, and Sircus (1959) that partial gastrectomy plus vagotomy is needed for the hypersecretors. While 10% is a commonly quoted figure for the incidence of recurrent ulceration after vagotomy and drainage operations (Sircus and Small, 1964), the 100 subjects providing this 10% recurrence rate are likely to include 30 whose vagotomy is incomplete as judged by the insulin test (Smithwick, 1958 ;Ross and Kay, 1964;Burge, 1964). Where the rate of incomplete vagotomy is much lower than the average, the incidence of recurrent ulcer is no higher than that after partial gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Medical vagotomy: an assessment.

Johnston¹,

Goligher²,

Duthie³

1966

BMJ

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Attempts have been made to predict the secretion of gastric acid after surgical vagotomy with a drainage procedure, by blocking the vagus nerves with atropine and hexamethonium or with propantheline in preoperative tests (McArthur, Tankel, and Kay, 1960;Gillespie and Kay, 1961;Checketts, Gillespie, and Kay 1966). These workers carried out two tests on their subjects before operation: the first was an augmented histamine test (Kay, 1953); in the second hexamethonium bromide 50 mg. and atropine 0.325 mg., or propantheline 30 mg., were given before the injection of histamine. If this drug-induced or " medical " vagal blockade in the second test brought about a large decrease in the response to histamine a similar large reduction in secretion was to be expected after surgical section of the vagi. On the other hand, in some patients the response to histamine was reduced by only a small amount (<35 %) after medical vagotomy, and some of these subjects also had a small reduction in secretion after surgical vagotomy. It was suggested that a minority of patients with duodenal ulcer had "antral dominance " over the production of gastric acid, the vagi playing a lesser part; that it might be possible to pick them out before operation by the " medical vagotomy " test; and that they would be better treated by vagotomy and antrectomy than by vagotomy and drainage alone.Our study is a critical examination of the above hypothesis, designed to answer the following questions: (1) (Lawrie, Smith, and Forrest, 1964), injecting atropine and hexamethonium when maximal levels of secretion have been attained after 90 to 105 minutes. The subjects were male patients with duodenal or gastric ulceration, hiatus hernia, dyspepsia without any abnormality on barium-meal examination, and normal individuals. After an overnight fast a 16 F.G. duodenal tube with a metal tip was passed transnasally into the stomach, the contents of which were aspirated by continuous suction wit'' an electric motor. The antihistamine mepyramine maleate (Anthisan) was given in a dose of 50-100 mg. intramuscularly at the start of the test. The histamine infusion was then set up, with either a paediatric drip set or a constant-infusion pump, to deliver 0.4 pg. of histamine acid phosphate per kg. per minute intravenously throughout the test. The gastric secretion was aspirated by continuous suction, and separate samples representing 15-minute periods were collected.After 90 to 105 minutes, when a steady rate of gastric secretion had been achieved, the medical vagotomy injection was given. Atropine sulphate 1.3 mg. (1/50 gr.) and hexamethonium bromide (C6) 50 mg. were given together intramuscularly. Gastric secretion was then collected for a further two hours (in 74 tests) or four hours (28 tests). The "maximal" acid secretion was taken as the mean of the two or three 15-minute collections immediately before the injection of atropine and hexamethonium, while "acid output after medical vagotomy" was taken as the mean of the two or three lowest consecutive readings, which...

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Section: Discussionmentioning

confidence: 99%

Medical vagotomy: an assessment.

Johnston¹,

Goligher²,

Duthie³

1966

BMJ

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“…However, there is a significant difference between the combined category I and II score of vagotomy and pyloroplasty and of vagotomy and antrectomy and subtotal gastrectomy when taken together (P<0.05). Discussion The present popularity of pyloroplasty instead of gastroenterostomy as the method of gastric drainage for use in conjunction with vagotomy is apparently based on its more physiological nature and on the expectation or finding of fewer postoperative symptoms due to disturbances of alimentary function, such as bilious vomiting, though a slightly higher incidence of recurrent ulceration has been reported by some authors (Weinberg et al, 1956 ;Burge, 1964 ;Holt and Lythgoe, 1965;Schofield et al, 1967). Our own data on the relative results of vagotomy and pyloroplasty and of other operative methods may be to some extent invalidated by dissimilarity in the series of cases we have contrasted-though assuredly not more so than in most other published comparisons of this kind.…”

Section: Visick Gradingmentioning

confidence: 99%

Clinical comparison of vagotomy and pyloroplasty with other forms of elective surgery for duodenal ulcer.

Goligher¹,

Pulvertaft²,

Dombal³

et al. 1968

BMJ

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Duodenal Ulcer-Goligher et al. MEDICAL JOURNAL 787 annually, and this paper describes the latest results obtained on them at follow-up five to eight years after operation:(1) Most " postgastric operation syndromes " occurred with roughly equal frequency after all three operations, but early dumping was marginally more common and severe after subtotal gastrectomy; however, it very seldom assujned crippling proportions. Diarrhoea was certainly more frequent after the two vagotomy operations than after gastrectomy, but most of it was very slight and occurred episodically, so that it was only rarely a source of disability.(2) A comparison between the postoperative weight of patients and the optimal weight of individuals of the same age and height, as calculated from life assurance tables, showed a distinctly greater reduction of weight after gastrectomy and vagotomy and antrectomy than after vagotomy and gastroenterostomy.(3) Recurrent ulceration was diagnosed in 7 to 10% of patients after vagotomy and gastroenterostomy and in 2 to 5 or 6% of patients after vagotomy and antrectomy or subtotal gastrectomy.(4) Overall assessment of the quality of the results (Visick grading) after the three operations showed vagotomy and antrectomy and subtotal gastrectomy to be slightly superior to vagotomy and gastroenterostomy, but the difference was statistically insignificant. The results of all operations tended to deteriorate gradually with the passage of time.The results in female patients were analysed only in those who had had vagotomy and gastroenterostomy. A comparison of the outcome of this operation in women and men, revealed that the results were distinctly poorer in the former, with I higher incidence of most postgastric operation symptoms and of recurrent ulceration than in men.We would like to express our thanks to the following for their assistance in the conduct of this study: Mrs. R. Nicolson, Mrs. M. A. Pybus, and Miss Lyn Alexander for secretarial services; Mrs. Dent for help in tracing patients; and the Medical

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“…The dogs were fully conscious throughout these vagotomy (Johnson and Boyden, 1952;Cox, Doherty, and Kerr, 1958;Griffith, 1962;Burge, 1964;Ruddick and Hutchinson, 1964). (During a gastrectomy the left gastric artery is ligated and thus damage or interruption of the hepatic branch of the left vagus nerve and of the coeliac branch of the posterior vagal nerve is usually present.)…”

Section: Clinical Evidencementioning

confidence: 99%

“…(During a gastrectomy the left gastric artery is ligated and thus damage or interruption of the hepatic branch of the left vagus nerve and of the coeliac branch of the posterior vagal nerve is usually present.) Griffith (1962) and Burge (1964) have also suggested that any effect on the gall-bladder would be abolished if only a selective vagotomy were carried out, so preserving the hepatic branch of the anterior vagus nerve and possibly also the coeliac branch of the posterior vagus nerve. This has been discredited by the work of Tinker and Cox (1969), who showed that gall-bladder emptying in response to insulin-induced hypoglycaemia and cholinergic and hormonal stimulation with carbachol and cholecystokinin was the same in patients after truncal or selective vagotomy.…”

Section: Clinical Evidencementioning

confidence: 99%

The influence of the vagus nerves on the biliary system

Hopton

1973

Journal of British Surgery

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Vagotomy has become accepted as a standard operation for the treatment of peptic ulcer during the past 15 years. Although used to treat a specific lesion in the stomach or duoddenum, vagus division can have a much wider effect on the digestive system, but little attentionhas been paid by most surgeons to the efffects of the vagus on other organs and it is timely to review the influence of the vagus nerves on the biliary system. In 1887 Ruggero Oddi suggested that the sphincter which is named after him was partly controlled by a nervous reflex. Since then many anatomists, physiologists, and clinicians have investigated the effects of the vagus nerves on the biliary system. The anatomical distribution of the vagus nerve and its hepatic and coeliac branches has been more thoroughly worked out than have their physiological effects.

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Selective Vagotomy

Cited by 9 publications

References 0 publications

Medical vagotomy: an assessment.

Medical vagotomy: an assessment.

Clinical comparison of vagotomy and pyloroplasty with other forms of elective surgery for duodenal ulcer.

The influence of the vagus nerves on the biliary system

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