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At least 19 recordsLinked to original sources
PubMed1989

Current status of proximal gastric vagotomy.

Proximal gastric vagotomy is nearing its twentieth year in clinical use as an operation for peptic ulcer disease. No other acid-reducing operation has undergone as much scrutiny or study. At this time, the evidence of such studies and long-term follow-up strongly supports the use of proximal gastric vagotomy as the treatment of choice for chronic duodenal ulcer in patients who have failed medical therapy. Its application in treating the complications of peptic ulcer disease, which recently have come to represent an increasingly greater percentage of all operations done for peptic ulcer disease, is well-tested. However, initial series suggest that it should probably occupy a prominent role in treating some of these complications, particularly in selected patients, in the future. The operation has the well-documented ability to reduce gastric acid production, not inhibit gastric bicarbonate production, and also minimally inhibit gastric motility. The combination of these physiologic results after proximal gastric vagotomy, along with preservation of the normal antropyloroduodenal mechanism of gastrointestinal control, serve to allow patients with proximal gastric vagotomy the improved benefits of significantly fewer severe gastrointestinal side effects than are seen after other operations for peptic ulcer disease.

Cimetidine↗
PubMedDate not supplied

Antral compensation after proximal gastric vagotomy.

Proximal gastric vagotomy (PGV) has little impact on the normal pattern of solid gastric emptying, despite denervation of the proximal two thirds of the stomach and loss of the proximal gastric pump. In four healthy volunteers and four patients with PGV, we investigated the possible compensatory mechanisms that may come into play after proximal denervation of the stomach. We measured antropyloroduodenal motility with a 10-lumen sleeve/side-hole catheter for 180 minutes after ingestion of a dual-isotope radiolabeled mixed liquid/solid meal. Patients with PGV exhibited faster liquid emptying, but the rate of solid emptying was similar to that in healthy volunteers. The frequency of propagated antropyloric pressure wave was similar between the two groups, but patients with PGV exhibited less isolated pressure waves in the proximal antrum. The amplitude and duration of pressure waves recorded in the distal antrum were significantly increased in the PGV patients as compared to healthy volunteers. Although the pattern of propagated antral contractions and solid gastric emptying remains unchanged after PGV, there is an increase in the amplitude and duration of distal antral contractions, which may compensate for loss of proximal gastric pumping mechanisms.

Adult↗
PubMed1994

Laparoscopic proximal gastric vagotomy.

Proximal gastric vagotomy, considered the conventional surgical treatment of choice for peptic ulcer disease, is now performed laparoscopically. Thirty-three patients underwent the procedure. Seven patients were treated on an emergency basis for perforated peptic ulcer. Morbidity and mortality of the procedure were zero. Patient acceptance (Visick staging) was good to excellent in 22 of 25 patients in follow-up. Laparoscopic proximal gastric vagotomy appears to be a good treatment in chronic peptic ulcer disease even when complicated by an acute perforation.

Adult↗
PubMed1997

Time-dependent changes of serum gastrin and gastrin receptors in the rat oxyntic mucosa after proximal gastric vagotomy.

Proximal gastric vagotomy (PGV) is a first-choice approach for the surgical treatment of duodenal peptic ulcer. However, a high percentage of recidivism takes place after this surgical strategy. To study the possible involvement of gastrin in ulcer recidivism, serum gastrin levels and gastrin receptors in gastric mucosa were determined at several times after PGV in rats. Gastrin concentration was determined using a commercial radioimmunoassay kit and gastrin receptors were analyzed in oxyntic mucosa membrane preparations using 125I-labeled 15-Leu-gastrin-17 as label. Our results show a significant, time-dependent increase in serum gastrin concentration, reaching highest values at 12 weeks after PGV. Similarly, a significant increase in the number of gastrin receptors (Bmax) and in the dissociation constant (Kd) occurred from 1 to 12 weeks post-PGV. Since gastrin exerts a positive feedback effect on its receptors, the PGV-dependent increase in serum gastrin concentration explains the up-regulation of the gastrin receptors in the rat oxyntic mucosa. Furthermore, an increase in the number of gastrin receptors after vagotomy may be at least partially responsible for the recidivism in duodenal peptic ulcers after this surgical approach.

Animals↗
PubMed1984

Long-term results of proximal gastric vagotomy.

Proximal gastric vagotomy without drainage for duodenal ulcer was performed in 304 patients between 1969 and 1977. There was one operative death (0.3%) and two patients required secondary drainage (0.6%). Eleven patients died subsequently of unrelated causes. Follow-up 5 to 13 years after operation was conducted on 242 patients (80%). Of these, 141 were asymptomatic and 48 had only trivial symptoms, a success rate of 78%. Thirty-two patients had recurrent ulcer and 2 of them had Zollinger-Ellison syndrome. When these two were excluded, the recurrence rate was 12.4%. Two patients had duodenitis. Seven patients had unexplained pain and some of them may ultimately be shown to have recurrence. Appreciable esophageal reflux was seen in eight patients. Other symptoms, nearly all mild, were dumping in one, diarrhea in seven and bile reflux in six. Recurrent ulcer was treated by cimetidine initially in all 32 cases but ultimately by repeat vagotomy and antrectomy in 27, with no deaths and only one further recurrence (Zollinger-Ellison syndrome). After operative correction, the ultimate success rate (Visick grades I and II) was 90%.

Abdomen↗
PubMed1978

The relative effects of lesser curvature vagotomy and esophageal vagotomy on the acid secretory effect of proximal gastric vagotomy.

Proximal gastric vagotomy is an operation consisting of division of all vagal fibers to the acid-secreting portion of the stomach. These fibers are usually divided along the lesser curvature of the stomach; however, because of a high rate of duodenal ulcer recurrence in some series, it has become apparent that it is important to divide the vagal fibers to the stomach leaving the main vagal trunks along the distal 5 cm of esophagus in order to achieve both adequate control of acid secretion and also a lower duodenal ulcer recurrence rate. The data presented in this study of ten mongrel dogs suggest that, in the dog, division of the vagal fibers along the lesser curvature is more important in reducing acid secretion than is esophageal vagotomy; but the data also emphasize the contribution of the vagal fibers along the distal esophagus since a marked reduction in 2 DG-stimulated acid secretion can only be achieved by dividing the vagal fibers around the distal esophagus as well as those along the lesser curvature.

Animals↗
PubMed1994

Influence of proximal gastric vagotomy on canine gastric motility and emptying.

BACKGROUND: The aim was to determine the effect of proximal gastric vagotomy on proximal gastric tone, distal gastric motility, and gastric emptying in seven conscious dogs. METHODS AND RESULTS: Before vagotomy, insulin (1 unit/kg intravenously) caused a prompt decrease in proximal gastric tone measured with a barostat and a marked increase in distal gastric motility measured with a perfused, pressure-sensitive catheter, both of which were maximal at 30 minutes. Proximal gastric tone then returned to the control level during the ensuing 30 minutes, whereas the increase in distal gastric motility continued. Gastric emptying of an inert marker, polyethylene glycol, was unchanged by insulin. After vagotomy, insulin again caused a prompt decrease in proximal gastric tone, an increase in distal gastric motility, and no change in gastric emptying of marker, but the decrease in proximal gastric tone now persisted for the entire hour after administration of insulin. CONCLUSIONS: Relaxation of the proximal stomach is mediated by pathways not solely dependent on the proximal gastric vagal nerves, but the ability to regain proximal gastric tone is impaired by proximal vagotomy. In contrast, vagal drive to distal gastric motility and gastric antral emptying are preserved after proximal gastric vagotomy.

Animals↗
PubMed1987

Endoscopic Congo red test during proximal gastric vagotomy.

Although proximal gastric vagotomy is widely performed as an elective treatment for duodenal ulcer, the incidence of recurrent ulcer is troublesome. There are several theories to explain recurrent ulcers, and important technical steps should be considered when performing proximal gastric vagotomy. The use of an intraoperative test may allow more accurate performance of the operation and more complete vagotomy of the parietal cell mass. This report describes the use of the endoscopic Congo red test in patients during proximal gastric vagotomy. The test allows rapid and accurate mapping of areas of the stomach with intact vagus and secretory nerves after operative vagotomy, and can be repeated several times if necessary to verify completion of the vagotomy. The use of universally available equipment and the potential for intraoperative and postoperative use are other attractive features of the test. Use of the endoscopic Congo red test provides physiologic evidence that vagus secretory nerve fibers traverse the right and left gastroepiploic nerves, leading us to believe that the gastroepiploic nerves should be routinely divided during proximal gastric vagotomy. In patients with recurrent duodenal ulcer requiring reoperation, the endoscopic Congo red test allows preoperative demonstration of the site of the intact vagal nerve trunks. The endoscopic Congo red test deserves further investigation and wider application during operations for chronic duodenal ulcer.

Congo Red↗
PubMed1978

Results of elective duodenal ulcer surgery in women: comparison of truncal vagotomy and antrectomy, gastric selective vagotomy and pyloroplasty, proximal gastric vagotomy.

This study provides a retrospective comparative analysis of results in 90 women patients who underwent three different elective operations for intractable duodenal ulcer disease. Group I (30 patients) underwent truncal vagotomy/antrectomy (TV + A); group II (30 patients) gastric selective vagotomy/pyloroplasty (GSV + P); and Group III proximal gastric vagotomy (PGV). There were no operative deaths among the 90 patients. No patient after TV + A has developed a recurrent ulcer. Two recurrent ulcers developed after GSV + P, and one gastric ulcer occurred after PGV. Dumping, diarrhea, and reflux gastritis were lower after PGV than with TV + A and GSV + P. Follow-up studies have been from six months to ten years. The clinical results among the three groups of women patients compare favorably with results obtained in a recent prospective randomized study using the identical operative procedures in three groups of men patients operated upon for intractability. There was no statistically significant difference between women and men after similar operative procedures, but the postgastrectomy sequelae were less after PGV in both women and men patients.

Adult↗
PubMedDate not supplied

Anterior lesser curve seromyotomy with posterior truncal vagotomy versus proximal gastric vagotomy: results of a prospective randomized trial 3-8 years after surgery.

In a prospective randomized trial, anterior lesser curve seromytomy with posterior truncal vagotomy (ASPTV, n = 50) was compared with proximal gastric vagotomy (PGV, n = 50). Most of our patients were young men with ASA grade I risk, and 80% were expatriates. They were followed up for 3 to 8 years after surgery. The mean reductions of basal acid output (BAO) and insulin-stimulated peak acid output (IPAO) were 85% and 88%, respectively, soon after surgery for both ASPTV and PGV groups. These values remained at 70% and 60% of their preoperative level for 1 year. Good to excellent results (Visick I and II) were recorded in 76% of cases in both groups. The recurrent ulcer rate was 14% for PGV and 12% for ASPTV. This trial suggests that for the treatment of duodenal ulcer ASPTV is as good an operation as PGV.

Adult↗
PubMed1988

Anterior lesser curve seromyotomy with posterior truncal vagotomy versus proximal gastric vagotomy.

In a prospective randomized trial anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV, n = 48) has been compared with proximal gastric vagotomy (PGV, n = 43). Eighty-eight and eighty-three patients were available for follow-up studies at 1 year and 2 years, respectively. Six months postoperatively the mean reduction in pentagastrin-stimulated peak acid output (PAO) was 48.5 per cent (s.d. 26.3) after PGV and 50.5 per cent (s.d. 23.3) after ASPTV. Two years after the operation satisfactory clinical results (Visick I + II) were found in 84.2 per cent of the patients after PGV and in 88.9 per cent after ASPTV. There was a significant difference in the duration of surgery. No serious postoperative gastric sequelae were encountered after either operation. Up till January 1987, eight endoscopically proven, symptomatic recurrent ulcers have been diagnosed: four in the PGV group (9.3 per cent) and four in the ASPTV group (8.7 per cent). The results of this randomized study suggest that ASPTV is as good as PGV in the surgical treatment of chronic duodenal ulcers.

Adult↗
PubMed1975

Gastric emptying following vagotomy and antrectomy and proximal gastric vagotomy.

Gastric emptying of solid meals labelled with 129Cs was studied in patients for up to one year after vagotomy and antrectomy or after proximal gastric vagotomy. Significant delay was found one month after vagotomy and antrectomy but this had returned to normal by six months. No delay was found after proximal gastric vagotomy. The effect of posture on gastric emptying was also studied in the same subjects. No significant differences were found between gastric emptying in the supine or sitting positions after solid meals.

Duodenal Ulcer↗
PubMed1983

Proximal gastric vagotomy: update.

Experience with proximal gastric vagotomy at the Mayo Clinic from 1973 to Mayo 1980 is reported. Among 298 patients who had proximal gastric vagotomy for chronic duodenal, pyloric channel, or prepyloric ulcers, a recurrent ulcer rate of 7% was present, with a mean follow-up of 49 months. Three recurrences developed in six patients who had proximal gastric vagotomy for gastric ulceration. In 40 patients, proximal gastric vagotomy was combined with gastrojejunostomy, pyloroplasty, or pyloric dilatation for obstructing ulcers. There was a 15% incidence of reoperation in the gastrojejunostomy group. All nine patients who had proximal gastric vagotomy for active or recent bleeding ulcers were dismissed from the hospital without further hemorrhage, and only one developed a recurrent ulcer. It is concluded that proximal gastric vagotomy remains an acceptable operation for chronic duodenal and pyloric ulcers, but its efficacy in gastric ulcers is unproved.

Female↗
PubMed1984

The effect of a segmental gastrectomy with proximal gastric vagotomy on gastric secretion and gastric emptying.

Gastric acid secretory responses to graded doses of pentagastrin were measured in duodenal ulcer patients before and after either proximal gastric vagotomy (17 patients) or proximal gastric vagotomy associated with a segmental gastrectomy (11 patients). Calculated maximal output of acid and responsiveness of the acid-secreting cells to pentagastrin were reduced by both operations; after surgery, maximal acid output was lower in the proximal gastric vagotomy plus segmental gastrectomy group than in the proximal gastric vagotomy group. Gastric emptying of a liquid meal was assessed before and after either proximal vagotomy (13 patients) or proximal gastric vagotomy plus segmental gastrectomy (9 patients). The early phase of emptying was equally accelerated by both operations, and at later stages the emptying was only slightly, but not significantly, faster following proximal gastric vagotomy associated with segmental gastrectomy.

Adolescent↗
PubMed1980

Proximal gastric vagotomy. Initial experience.

Proximal gastric vagotomy was performed in 223 patients with chronic duodenal ulceration between 1973 and 1977. The follow-up ranged from 6 to 78 months with a mean of 39 months. There was no operative mortality. Adverse postoperative sequelae, including delayed gastric emptying, dumping, diarrhea, and reflux gastritis, were seen in less than 3% of patients. Ulcers recurred in 11 patients (4.9%). We conclude that proximal gastric vagotomy is an effective, safe, and satisfactory operation for chronic duodenal ulcer over the short term.

Chronic Disease↗
PubMed1977

Electrical, contractile, and radiographic studies of the stomach after proximal gastric vagotomy.

The effects of proximal gastric vagotomy on the gastric electrical and contractile activities and on gastric emptying of solid food were studied in dogs. Proximal gastric vagotomy produced only minimal alteration of the electrical activity and did not significantly alter the response of the electrical and contractile activities to vagal stimulation (insulin) and local stimulation (food). Barium meal studies showed no delay in gastric emptying time after proximal gastric vagotomy but significant delay after truncal vagotomy. The findings support the clinical impression that gastric motility and empyting (solid) remain relatively normal after proximal gastric vagotomy.

Action Potentials↗