VAGO T O M Y
LUCIS
MAQUILAN
MARAVILES
MARQUEZ
MATA
WHAT IS VAGOTOMY?
• A VAGOTOMY IS A MEDICAL INTERVENTION TO
INTERRUPT SIGNALS CARRIED BY YOUR VAGUS
NERVE.
• IT IS USUALLY MEANS CUTTING THE BRANCH OF
THE VAGUS NERVE THAT TELLS YOUR STOMACH
TO SECRETE GASTRIC ACID.
• IT IS DONE TO TREAT SEVERE CASES OF PEPTIC
ULCER DISEASE.
• EXCESSIVE PRODUCTION
OF GASTRIC ACID CAN
LEAD TO THE FORMATION
OF PAINFUL SORES
CALLED PEPTIC ULCERS
IN THE LINING OF THE
STOMACH AND
DUODENUM.
THE VAGUS NERVE IS MADE UP OF FOLLOWING BRANCHES:
1. ANTERIOR TRUNK- SUPPLIES TO LIVER AND
GALL BLADDER
2. POSTERIOR TRUNK- SENDS BRANCHES TO
THE SOLAR PLEXUS (A MAJOR JUNCTION
FOR NERVES SUPPLYING TO UPPER
ABDOMEN)
• VAGOTOMIES ARE TRADITIONALLY DONE TO TREAT
PEPTIC ULCERS BY REDUCING THE AMOUNT OF
ACID YOUR STOMACH PRODUCES. THESE DAYS,
WHY IS IT IT’S RARELY DONE ON ITS OWN. INSTEAD, PEOPLE
DONE? USUALLY START TAKING ANTIBIOTICS TO CLEAR
UP AN H. PYLORI INFECTION OR
PROTON PUMP INHIBITORS TO REDUCE STOMACH
ACID.
IF MEDICATIONS ALONE AREN’T ENOUGH, YOUR DOCTOR MIGHT SUGGEST A VAGOTOMY
PROCEDURE IN COMBINATION WITH:
• RESECTION. YOUR DOCTOR REMOVES A DAMAGED OR DISEASED PART OF YOUR DIGESTIVE
TRACT.
• ABDOMINAL DRAINAGE. THIS REMOVES EXTRA ABDOMINAL FLUID, CALLED ASCITES.
• DIVERSION. YOUR GI TRACT IS MODIFIED SO THAT THE DIGESTION PROCESS MOVES
AROUND THE DAMAGED OR DISEASED PART.
• PYLOROPLASTY. THIS PROCEDURE WIDENS THE PYLORUS, WHICH IS LOCATED NEAR THE
END OF YOUR STOMACH. IT HELPS TO CONTROL THE MOVEMENT OF PARTIALLY DIGESTED
FOOD AND DIGESTIVE JUICES INTO YOUR SMALL INTESTINE.
1. TRUNCULAR VAGOTOMY
2. SELECTIVE VAGOTOMY
3. HIGHLY SELECTIVE VAGOTOMY
TYPES OF VAGOTOMY
1. TRUNCAL VAGOTOMY
• THIS TYPE IS COMMONLY USED WITH PYLOROPLASTY OR ABDOMINAL DRAINAGE
TO TREAT CHRONIC PEPTIC ULCERS. IT INVOLVES CUTTING ONE OR MORE OF THE
BRANCHES THAT SPLIT OFF THE MAIN TRUNK OF THE VAGUS NERVE AND TRAVEL
DOWN YOUR ESOPHAGUS TO YOUR STOMACH AND OTHER DIGESTIVE ORGANS.
2. SELECTIVE VAGOTOMY
• THIS OPTION CUTS THE VAGUS NERVE FURTHER DOWN, CLOSER TO YOUR
ORGANS, SO THAT ONLY SOME OF ITS FUNCTION IS REMOVED. IT’S A GOOD
OPTION FOR TREATING STOMACH ULCERS WITHOUT HAVING A HUGE
IMPACT ON OTHER ORGANS THAT RELY ON THE VAGUS NERVE, SUCH AS
YOUR LIVER.
3. HIGHLY SELECTIVE VAGOTOMY
• LIKE A SELECTIVE VAGOTOMY, THIS TYPE INVOLVES ONLY CUTTING THE
PART OF THE VAGUS NERVE THAT DIRECTLY AFFECTS YOUR STOMACH,
PRESERVING MANY OF THE VAGUS NERVE’S OTHER FUNCTIONS. THIS TYPE
IS COMMONLY DONE ALONG WITH TRUNCAL VAGOTOMY.
PATIENT PREPARATION
• ANESTHESIA
GENERAL ANESTHESIA IS USED FOR THIS PROCEDURE.
• POSITIONING
THE PATIENT IS PLACED IN THE SUPINE POSITION; A SLIGHT REVERSE TRENDELENBURG (HEAD
UP) ORIENTATION MAY BE USED IN ORDER TO DISPLACE THE INTESTINES CAUDAD. FOR THE
THORACIC APPROACH, THE PATIENT IS PLACED IN A RIGHT LATERAL (LEFT SIDE UP) POSITION.
EQUIPMENT
• A TABLE-MOUNTED STERNAL
ELEVATOR AND A SELF-RETAINING
ABDOMINAL WALL RETRACTOR MAY
OBVIATE THE NEED FOR AN
ASSISTANT.
WHAT’S RECOVERY LIKE?
• NEED TO STAY IN THE HOSPITAL FOR ABOUT A WEEK
• YOUR DOCTOR MAY NEED TO PERIODICALLY DRAIN EXTRA STOMACH ACID WHILE MONITORING YOUR BODY’S
RESPONSE TO THE PROCEDURE.
• AFTER ABOUT A WEEK, YOUR DOCTOR WILL ALSO REMOVE YOUR STITCHES, UNLESS YOU HAVE DISSOLVABLE ONES.
• IT CAN TAKE ABOUT SIX WEEKS TO FULLY RECOVER. DURING THIS TIME, YOUR DOCTOR MIGHT RECOMMEND
FOLLOWING A LIQUID DIET UNTIL YOUR GI TRACT ADAPTS TO CHANGES IN THE FUNCTION OF YOUR VAGUS NERVE.
• AVOID ACIDIC OR SPICY FOODS AS MUCH AS POSSIBLE
INDICATIONS
VAGOTOMY IS INDICATED AS MANAGEMENT OF PUD IN THE FOLLOWING CASES:
• ELECTIVE - FAILURE OF MEDICAL TREATMENT (WITH THE AVAILABILITY OF EFFECTIVE ACID SUPPRESSION WITH H2RAS AND PPIS;
HOWEVER, THIS INDICATION HAS BECOME VIRTUALLY NONEXISTENT)
• SEMIELECTIVE - PYLORIC STENOSIS (OBSTRUCTION) DUE TO PUD (VAGOTOMY IS PERFORMED AS AN ADJUNCT TO A PYLORIC
DRAINAGE OR BYPASS PROCEDURE)
• EMERGENCY - UPPER GASTROINTESTINAL (GI) BLEEDING DUE TO PUD OR STRESS GASTRIC ULCERS (EROSIVE GASTRIC MUCOSAL
[3]
DISEASE) OR PERFORATED PUD THAT IS CAUSING GENERALIZED PERITONITIS
• INCIDENTAL - AN INADVERTENT VAGOTOMY IS PERFORMED DURING ESOPHAGECTOMY OR
ESOPHAGOGASTRIC DEVASCULARIZATION FOR BLEEDING VARICES CAUSED BY PORTAL HYPERTENSION; AFTER THIS, THE PYLORUS
IS USUALLY DISRUPTED (DILATATION, PYLOROMYOTOMY, OR PYLOROPLASTY), BUT SOME SURGEONS LEAVE IT (THE PYLORUS)
INTACT
CONTRAINDICATIONS
• VIRTUALLY NO CONTRAINDICATION FOR VAGOTOMY EXISTS; HOWEVER,
INDICATIONS FOR ITS USE HAVE BECOME LESS COMMON.
ARE THERE ANY RISKS INVOLVED?
VAGOTOMY PROCEDURES CARRY THE SAME POTENTIAL RISKS AS MANY OTHER TYPES OF
SURGERY, INCLUDING:
INTERNAL BLEEDING
INFECTIONS
SHOCK FROM BLOOD LOSS
DEEP VEIN THROMBOSIS
TROUBLE URINATING
ALLERGIC REACTIONS TO ANESTHESIA
YOU ALSO RUN THE RISK OF DEVELOPING DUMPING SYNDROME. THIS CAUSES FOOD TO
QUICKLY PASS THROUGH YOUR STOMACH WITHOUT BEING PROPERLY DIGESTED. IT
SYMPTOMS INCLUDE:
STOMACH CRAMPS
NAUSEA AND VOMITING
DIARRHEA
RAPID HEARTBEAT AFTER EATING
THESE SYMPTOMS CAN COME ON RIGHT AFTER THE PROCEDURE AND BECOME LESS
SEVERE AS YOUR DIGESTIVE SYSTEM ADAPTS.
THAN K Y O U ! ! !
BSN4- 3
