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Namdev A, Jain D. Floating Drug Delivery Systems: An Emerging Trend for the Treatment of Peptic Ulcer. Curr Drug Deliv 2020; 16:874-886. [PMID: 31894738 DOI: 10.2174/1567201816666191018163519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/13/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022]
Abstract
Floating drug delivery system (FDDS) is the main approach to prolonging the gastric residence time in the stomach in which the bilayer floating tablet has the main role. It is more suitable for the treatment of local infections such as peptic ulcer, gastritis, Zollinger-Ellision syndrome, indigestion, and other local infections related to the gastrointestinal tract and also used for systemic applications. FDDS provides protection for those drugs which are acid labile and have a short half-life. It also improves bioavailability, reduces drug waste, and enhances the residence time of drugs. Nowadays, various technologies are being used for the development of FDDS. Novel drug delivery systems incorporation into bilayer floating tablets have also broadened the role of FDDS. Polymers have the main role in the development of FDDS, which serve as carriers for the drug and determine the gastric retention time and drug protection. FDDS is also an easy, cheap, and more convenient method for dual drug delivery of drugs.
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Affiliation(s)
- Ankit Namdev
- Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Central University, Sagar (MP), India
| | - Dharmendra Jain
- Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Central University, Sagar (MP), India
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The vagus neurometabolic interface and clinical disease. Int J Obes (Lond) 2018; 42:1101-1111. [PMID: 29795463 DOI: 10.1038/s41366-018-0086-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
The nervous system both monitors and modulates body metabolism to maintain homoeostasis. In disease states such as obesity and diabetes, the neurometabolic interface is dysfunctional and contributes to clinical illness. The vagus nerve, in particular, with both sensory and motor fibres, provides an anatomical substrate for this interface. Its sensory fibres contain receptors for important circulating metabolic mediators, including leptin and cholecystokinin, and provide real-time information about these mediators to the central nervous system. In turn, efferent fibres within the vagus nerve participate in a brain-gut axis to regulate metabolism. In this review, we describe these vagus nerve-mediated metabolic pathways and recent clinical trials of vagus nerve stimulation for the management of obesity. These early studies suggest that neuromodulation approaches that employ electricity to tune neurometabolic circuits may represent a new tool in the clinical armamentarium directed against obesity.
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Abstract
OBJECTIVE Truncal vagotomy is associated with a decreased risk of subsequent Parkinson disease (PD), although the effect of vagotomy on dementia is unclear. In response, we investigated the risk of dementia in patients who underwent vagotomy. SETTING Population-based cohort study. PARTICIPANTS A total of 155 944 patients who underwent vagotomy (vagotomy cohort) and 155 944 age-matched, sex-matched and comorbidity-matched controls (non-vagotomy cohort) were identified between 2000 and 2011. PRIMARY AND SECONDARY OUTCOME MEASURES All patient data were tracked until the diagnosis of dementia, death or the end of 2011. The cumulative incidence of subsequent dementia and HRs were calculated. RESULTS The mean ages of the study patients in the vagotomy and non-vagotomy cohorts were 56.6±17.4 and 56.7±17.3 years, respectively. The overall incidence density rate for dementia was similar in the vagotomy and non-vagotomy cohorts (2.43 and 2.84 per 1000 person-years, respectively). After adjustment for age, sex and comorbidities such as diabetes, hypertension, hyperlipidaemia, stroke, depression, coronary artery disease and PD, the patients in the vagotomy cohort were determined to not be at a higher risk of dementia than those in the non-vagotomy cohort (adjusted HR=1.09, 95% CI 0.87 to 1.36). Moreover, the patients who underwent truncal vagotomy were not associated with risk of dementia (adjusted HR=1.04, 95% CI 0.87 to 1.25), compared with the patients who did not undergo vagotomy. CONCLUSION Vagotomy, either truncal or selective, is not associated with risk of dementia.
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Grants
- This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW106-TDU-B-212-113004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036), Taiwan Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo AoshimaMemorial Funds, Japan. The funders had no role in the study design, data
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Kirk RM. The Size of the Pyloroduodenal Canal: Its Relation to the Cause and Treatment of Peptic Ulcer. Proc R Soc Med 2016. [DOI: 10.1177/003591577006300936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R M Kirk
- Hampstead General Hospital, London NW3
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Sagatun L, Jianu CS, Fossmark R, Mårvik R, Nordrum IS, Waldum HL. The gastric mucosa 25 years after proximal gastric vagotomy. Scand J Gastroenterol 2014; 49:1173-80. [PMID: 25157752 DOI: 10.3109/00365521.2014.950979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Vagotomy causes inhibition of basal and post-prandial acid secretion in humans, but the knowledge about the trophic effect of the vagal nerves is limited. Vagotomy is known to induce hypergastrinemia and we aimed to study the long-term effects of proximal gastric vagotomy (PGV) on the oxyntic mucosa and the enterochromaffin-like (ECL) cell density in particular. MATERIAL AND METHODS Eleven patients operated with PGV because of duodenal ulcer and age- and sex-matched controls were examined 26 to 29 years postoperatively by gastroscopy with biopsies from the antrum and oxyntic mucosa. Neuroendocrine cell volume densities were calculated after immunohistochemical labeling of gastrin, the general neuroendocrine cell marker chromogranin A (CgA) and the ECL cell marker vesicular monoamine transporter 2 (VMAT2). Gastritis was graded and Helicobacter pylori (H. pylori) status was determined by polymerase chain reaction of gastric biopsies. Fasting serum gastrin and CgA were measured. RESULTS Serum gastrin was higher in the PGV group compared to controls (median 21.0 [interquartile range (IQR) = 22.0] pmol/L vs 13.0 [IQR = 4.0] pmol/L, p = 0.04). However, there was neither a significant difference in serum CgA or in CgA (neuroendocrine) nor VMAT2 (ECL cell) immunoreactive cell volume density in the oxyntic mucosa. There was significantly more inflammation and atrophy in H. pylori-positive patients, but PGV did not influence the grade of gastritis. CONCLUSION Despite higher serum gastrin concentrations, patients operated with PGV did not have higher ECL cell mass or serum CgA. Vagotomy may prevent the development of ECL cell hyperplasia caused by a moderate hypergastrinemia.
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Affiliation(s)
- Liv Sagatun
- Department of Gastroenterology and Hepatology, St Olavs Hospital , Trondheim , Norway
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The anatomy of a weight recidivism and revision bariatric surgical clinic. Gastroenterol Res Pract 2014; 2014:721095. [PMID: 24672540 PMCID: PMC3942332 DOI: 10.1155/2014/721095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.
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Lagoo J, Pappas TN, Perez A. A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease. Am J Surg 2013; 207:120-6. [PMID: 24139666 DOI: 10.1016/j.amjsurg.2013.02.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Given the rise of medical treatment for peptic ulcer disease (PUD), surgical treatment is necessary only in select cases and emergencies. The authors assess the current relevance of surgical vagotomy to treat PUD and its complications. DATA SOURCES Although historically significant, selective and highly selective vagotomy is very technically challenging, and highly selective vagotomy has a relatively narrow indication and high recurrence rates. Vagotomy and gastrectomy is associated with significant side effects. Two types of vagotomy remain relevant, within a narrow scope. Truncal vagotomy and pyloroplasty is safe and efficacious through a laparoscopic approach in certain emergent cases. Vagotomy and Roux-en-Y gastrojejunostomy can be used to treat severe PUD refractory to medical management. CONCLUSIONS The role of vagotomy in the management of PUD has a rich history but predated pharmacologic control of acid and understanding of the role of Helicobacter pylori in the disease. Thus, the current role of vagotomy is significantly limited. Specifically, the emergent use of truncal vagotomy is warranted for patients who are either resistant or allergic to proton pump inhibitors.
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Affiliation(s)
- Janaka Lagoo
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Theodore N Pappas
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alexander Perez
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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History of Surgery of the Gastrointestinal Tract. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lipof T, Shapiro D, Kozol RA. Surgical perspectives in peptic ulcer disease and gastritis. World J Gastroenterol 2006; 12:3248-52. [PMID: 16718847 PMCID: PMC4087970 DOI: 10.3748/wjg.v12.i20.3248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 04/06/2006] [Accepted: 04/16/2006] [Indexed: 02/06/2023] Open
Abstract
For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
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Affiliation(s)
- Tamar Lipof
- Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, MC 3955 Farmington, CT 06030-3955, USA
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Chang TM, Chan DC, Liu YC, Tsou SS, Chen TH. Long-term results of duodenectomy with highly selective vagotomy in the treatment of complicated duodenal ulcers. Am J Surg 2001; 181:372-6. [PMID: 11438277 DOI: 10.1016/s0002-9610(01)00580-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Highly selective vagotomy and complete circular or partial duodenectomy have been applied to complicated duodenal ulcer for many years. These procedures seem to provide better clinical results than truncal vagotomy and antrectomy. METHODS A retrospective analysis was conducted of 120 patients with complicated duodenal ulcer who underwent surgical treatment between 1986 and 1999. Patients with obstruction were treated with either circular complete (17) or partial duodenectomy (3) combined with highly selective vagotomy or truncal vagotomy and antrectomy (37). Those with perforation were treated primarily with highly selective vagotomy and partial duodenectomy, highly selective vagotomy alone, or truncal vagotomy and pyloroplasty. Every patient was followed up either by a clinic visit (75%) or questionnaire to determine the presence of ulcer pain, dumping, diarrhea, vomiting, weight loss, and Visick grade. RESULTS Long-term follow-up of patients treated with duodenectomy and highly selective vagotomy for obstruction showed that 94% had sustained weight gain whereas more than half of those treated with truncal vagotomy and antrectomy had weight loss. In patients with perforation, duodenectomy and highly selective vagotomy offered no advantage over highly selective vagotomy alone. CONCLUSIONS Highly selective vagotomy and complete circular or partial duodenectomy provide fewer sequelae and better weight gain long term than truncal vagotomy and antrectomy for patients with obstructing duodenal ulcers.
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Affiliation(s)
- T M Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, People's Republic of China.
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Macintyre I. Peptic Ulcer Surgery - An Obituary (Part Two). J R Coll Physicians Edinb 2000. [DOI: 10.1177/147827150003000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zanchi P, Schlumph R, Aras N, Schob O, Schmid R, Petricevic A, Largiader F. Surg Laparosc Endosc Percutan Tech 1997; 7:42-46. [DOI: 10.1097/00019509-199702000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Fletcher DR. Peptic disease: can we afford current management? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1997; 67:75-80. [PMID: 9068546 DOI: 10.1111/j.1445-2197.1997.tb01908.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND While surgery has the potential to cure peptic disease (ulceration and reflux), the development in the 1970s of H2 receptor antagonists saw them replace surgery in the management of peptic symptoms, controlling disease while the medication was taken. Medical cure at least in the case of a duodenal ulcer is now also possible by the use of anti-Helicobacter therapy. METHODS Australian Pharmaceutical Benefits Scheme (PBS) and Medicare data on the treatment of peptic disease were reviewed. RESULTS The data showed that medical cure of duodenal ulcer is rarely attempted. While elective surgical treatment for duodenal ulcer, highly selective vagotomy, has decreased 10-fold in 10 years, prescriptions for antisecretory agents (H2 and proton pump) are doubling every 2 years (increasing from 6.7 to 7.8% of PBS budget). Meanwhile upper gastrointestinal endoscopy rates are doubling every 5 years. By comparison, the most appropriate treatment, anti-Helicobacter therapy, is prescribed at 1/50th the rate of antisecretory agents and over 2 years decreased to 1/80th. Antisecretory treatment has not been effective in reducing mortality from duodenal ulcer, at least not in New South Wales. CONCLUSIONS If the principle of treatment is to decrease cost and prevent complications by curing duodenal ulcer, then current practice is a failure. A management algorithm for peptic symptoms which has the potential to relieve symptoms, cure ulcer when present, minimize surgery and reduce complications and cost is proposed for the purpose of debate.
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Affiliation(s)
- D R Fletcher
- University Department of Surgery, Fremantle Hospital, Australia
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Ihász M, Bátorfi J, Bálint A, Fazekas T, Máté M, Pòsfai G, Sándor J. Long-term clinical results of highly selective vagotomy performed between 1980 and 1990. Surg Today 1996; 26:546-51. [PMID: 8840440 DOI: 10.1007/bf00311565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.
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Affiliation(s)
- M Ihász
- Third Department of Surgery, Semmelweis Medical University, Budapest, Hungary
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Amdrup E, Hovendal CP, Jensen HE. Vagotomy. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1996; 216:16-9. [PMID: 8726274 DOI: 10.3109/00365529609094556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Peptic ulcer disease was for years a common indication for surgery in Danish hospitals and considerable experience in partial gastrectomy was gained. In spite of an unquestionable mortality rate and a number of patients having postgastrectomy complaints, results were generally recognized as acceptable. Danish surgeons were for long reluctant to take up vagotomy and drainage as a primary ulcer operation, but when they did start a large number of procedures were performed. In fact, the use of this treatment culminated during two to three decades. However, on a basis of experiences from these years, Danish research contributed actively to the international evolution of the surgical vagotomy technique, the evaluation of clinical results and the studies of postoperative alterations in gastric physiology. References are selected from an extensive literature and are in no way complete.
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Affiliation(s)
- E Amdrup
- Dept. of Surgical Gastroenterology, Aarhus University, Copenhagen, Denmark
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Stenquist B, Forssell H, Olbe L, Lundell L. Role of acid secretory response to sham feeding in predicting recurrent ulceration after proximal gastric vagotomy. Br J Surg 1994; 81:1002-6. [PMID: 7922046 DOI: 10.1002/bjs.1800810724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The completeness of vagal denervation in determining the long-term outcome of patients with duodenal ulcer disease after proximal gastric vagotomy (PGV) was studied by examining the relationship between the postoperative acid secretory response to sham feeding ('chew and spit' technique) and the subsequent ulcer recurrence rate during a mean follow-up of 7.5 (range 5-15) years. The cumulative recurrence rate of 98 patients analysed prospectively was 11 per cent. Of 22 patients who had incomplete vagotomy as suggested by the sham feeding response, five had a later relapse. This compares with only an 8 per cent relapse rate among those with a secretory response suggesting complete vagotomy. Four patients suffered from a relapse more than 5 years after operation but none had undergone incomplete vagotomy. However, in seven patients with an early postoperative relapse (within 5 years) five had had incomplete vagal denervation (P < 0.05). In this latter group the median time elapsed from surgery until the first recurrence was only 1 year. It is concluded that the early postoperative acid secretory response to a sham feeding stimulus is clinically useful as it allows prediction of the risk of early relapse after PGV. This test may be helpful for the validation of new techniques of vagotomy.
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Affiliation(s)
- B Stenquist
- Department of Surgery, Sahlgren Hospital, University of Gothenburg, Sweden
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McKernan JB. Duodenal ulcer disease and gastric cancer: vagotomy, drainage and resection. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1993; 7:823-31. [PMID: 8118075 DOI: 10.1016/0950-3528(93)90017-m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Laparoscopic adaptation of highly selective vagotomy procedures associated with no mortality, low morbidity and no reports of diarrhoea and dumping syndrome has been reported. Although experience to date with these procedures is limited, they hold the promise of being a viable alternative for patients refractory to medical therapy or for those non-complaint with long-term maintenance pharmacologic treatment. Simple closure of an acute perforated ulcer has also been accomplished laparoscopically. In performing laparoscopic surgical procedures for duodenal ulcer disease, the relief of symptoms appears similar to that reported following comparable open procedures but with the advantages of diminished postoperative pain and disability. Moreover, the use of angled endoscopes and the magnification afforded by laparoscopy greatly facilitate the identification and transection of small vagal fibres adjacent to the oesophagus.
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Csendes A, Maluenda F, Braghetto I, Schutte H, Burdiles P, Diaz JC. Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Am J Surg 1993; 166:45-9. [PMID: 8101050 DOI: 10.1016/s0002-9610(05)80580-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.
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Affiliation(s)
- A Csendes
- Department of Surgery, University of Chile Clinical Hospital, Santiago
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Chisholm EM, Raimes SA, Leong HT, Chung SC, Li AK. Proximal gastric vagotomy and anterior seromyotomy with posterior truncal vagotomy assessed by the endoscopic congo red test. Br J Surg 1993; 80:737-9. [PMID: 8330161 DOI: 10.1002/bjs.1800800625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The completeness of vagotomy following proximal gastric vagotomy or anterior seromyotomy with posterior truncal vagotomy was assessed prospectively in 48 patients using the intraoperative congo red test. Pentagastrin (6 micrograms/kg) was given subcutaneously before the assessment. An endoscope was passed into the stomach and 180 ml congo red solution washed over the gastric mucosa. Continuing acid production was indicated by the appearance of a black colour (pH < 3) 2 min after introduction of the dye. A grading system was adopted where grades I and II showed little black discoloration and grades III and IV showed increasing areas of discoloration indicating that further denervation was required. All 20 patients undergoing anterior seromyotomy with posterior vagotomy were classified as grade I. Fifteen of an initial 23 patients receiving proximal gastric vagotomy were grade III or IV. Following division of either the right gastroepiploic nerve or the posterior vagal trunk, 22 patients improved to grade I (16) or II (six). In the subsequent five proximal vagotomies, modification of the dissection produced grade I results. Anterior seromyotomy with posterior truncal vagotomy gave consistently complete vagotomy. The congo red test highlighted major differences in the adequacy of vagotomy achieved using various dissection techniques during proximal gastric vagotomy. The test is a useful, reproducible and simple intraoperative method for assessing the completeness of denervation.
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Affiliation(s)
- E M Chisholm
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories
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Emås S, Grupcev G, Eriksson B. Six-year results of a prospective, randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers. Ann Surg 1993; 217:6-14. [PMID: 8424702 PMCID: PMC1242727 DOI: 10.1097/00000658-199301000-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.
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Affiliation(s)
- S Emås
- Department of Surgery, Karolinska Hospital, Stockholm, Sweden
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25
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Affiliation(s)
- T R Schrock
- University of California, San Francisco 94143-0144
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26
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Abstract
The optimal treatment of duodenal ulcer disease today requires familiarity with a variety of operative approaches. Experience and judgment are needed to select the best procedure for the individual patient presenting with a specific ulcer complication. Improved medical therapy has relegated surgery largely to the role of emergency life-saving intervention. Nonetheless, the goal of surgery remains cure of the ulcer diathesis with avoidance of postoperative side effects. Toward this end, proximal gastric vagotomy has proved itself to be the operation of choice, not only for intractable pain, but also for perforation and perhaps for bleeding in selected good-risk patients. Its efficacy in the treatment of obstructing duodenal ulcer has not been demonstrated. Modifications of proximal gastric vagotomy, including the use of laparoscopic techniques, are currently being evaluated in patients with intractable duodenal ulcer pain.
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Affiliation(s)
- B E Stabile
- Department of Surgery, University of California, San Diego School of Medicine
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Affiliation(s)
- P H Jordan
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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Paimela H, Tuompo PK, Peräkyl T, Saario I, Höckerstedt K, Kivilaakso E. Peptic ulcer surgery during the H2-receptor antagonist era: a population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987. Br J Surg 1991; 78:28-31. [PMID: 1671826 DOI: 10.1002/bjs.1800780110] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To evaluate the effects of improvements in medical therapy on the incidence of, indications for and operative methods used in peptic ulcer surgery, all cases of primary peptic ulcer surgery among adults in the city of Helsinki in the years 1972, 1977, 1982 and 1987 were analysed. There was a total of 565 such cases in a population which consisted of 5.2 X 10(5) individuals in 1972 and 4.8 X 10(5) individuals in 1987. The introduction of H2-receptor antagonists in 1979 was associated with a fall in the annual incidence of elective duodenal ulcer operations, from 15.5 to 6.7 per 10(5) individuals, and a fall in the annual incidence of elective gastric ulcer operations, from 9.4 to 3.1 per 10(5) individuals (P less than 0.05). The decrease was greatest among males with duodenal ulcer. In contrast, the annual incidence of emergency surgery for ulcer haemorrhage and perforation (all types of ulcers) remained relatively stable, varying from 7.2 to 10.2 per 10(5) inhabitants over the observation period (n.s.). The mean age of patients undergoing elective surgery remained essentially unchanged. The mean age of patients undergoing emergency surgery increased. The decrease in the annual incidence of elective duodenal ulcer surgery occurred mainly in relation to proximal gastric vagotomy. There was a concomitant relative increase in the incidence of gastric resection. The types of operative procedures used in cases of pyloric, prepyloric and gastric ulcer remained unchanged over the years 1972 to 1987.
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Affiliation(s)
- H Paimela
- Department of Surgery, Malmi Helsinki City Hospital, Finland
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29
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Pollard SG, Friend PJ, Dunn DC, Hunter JO. Highly selective vagotomy with duodenal dilatation in patients with duodenal ulceration and gastric outlet obstruction. Br J Surg 1990; 77:1365-6. [PMID: 2276020 DOI: 10.1002/bjs.1800771215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S G Pollard
- Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
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31
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Mistiaen W, Van Hee R, Blockx P, Hubens A. Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy. Dig Dis Sci 1990; 35:310-6. [PMID: 2307076 DOI: 10.1007/bf01537407] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.
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Affiliation(s)
- W Mistiaen
- Department of Surgical Research University of Antwerp, Belgium
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32
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Koruth NM, Dua KS, Brunt PW, Matheson NA. Comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty: results at 8-15 years. Br J Surg 1990; 77:70-2. [PMID: 2302517 DOI: 10.1002/bjs.1800770125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 1983 we reported the early results (mean 5 years) of a prospective randomized comparison of highly selective vagotomy (HSV) with truncal vagotomy and pyloroplasty (TVP) where all 137 operations were performed by the same surgeon. HSV was significantly better than TVP in terms of Visick grading and side-effects. The same patients were assessed at a mean of 12 years (range 8-15 years) after operation. There was no difference on assessment using Visick grading between TVP (59 patients) and HSV (57 patients) (grades I and II, 75 per cent in each case). However, 20 per cent of TVP patients (but none of the HSV patients) had undergone reoperation in the intervening period. The endoscopically proven recurrence rate was 7 per cent after TVP and 5 per cent after HSV. This long-term follow-up supports the optimism that HSV is a better operation than TVP in the elective treatment of duodenal ulcer.
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Affiliation(s)
- N M Koruth
- Department of Surgery, University of Aberdeen, UK
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33
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Dixon MF. Progress in the pathology of gastritis and duodenitis. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1990; 81:1-40. [PMID: 2407435 DOI: 10.1007/978-3-642-74662-8_1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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34
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Derbyshire SA, Lagopoulos M, Lee T, Primrose JN. Distribution of the vagus nerve to the human pyloric antrum and possible surgical implications. Clin Anat 1990. [DOI: 10.1002/ca.980030104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Bowden TA, Hooks VH, Rogers DA. Role of highly selective vagotomy and duodenoplasty in the treatment of postbulbar duodenal obstruction. Am J Surg 1990; 159:15-9; discussion 19-20. [PMID: 2294792 DOI: 10.1016/s0002-9610(05)80601-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The indications for highly selective vagotomy have expanded in recent years, with the technique being applied to selected cases of perforation and bleeding. Its use in obstruction is controversial, but two options are available for managing the stenotic pylorus or duodenum: dilatation or duodenoplasty. The latter choice requires that the stenosis be located in the postbulbar area. Since 1981, we have managed 15 patients with postbulbar stenosis by means of highly selective vagotomy and duodenoplasty. All patients had a previous history of ulcer disease, and vomiting was a consistent symptom. All patients were referred for surgery, 10 by a gastroenterologist. There was no operative mortality or procedure-related morbidity. Two patients have been lost to follow-up. Both were classified as Visick I and had normal endoscopic results at their last visit. The remaining 13 patients have all been followed very recently. Twelve patients (92%) are currently classified as Visick I or II. One patient (Visick IV), who was essentially asymptomatic, was found to have a recurrent ulcer on endoscopy. Endoscopic (11 patients) or radiographic (1 patient) patency of the duodenoplasty has been demonstrated in 12 patients. Highly selective vagotomy and duodenoplasty should be a surgical consideration when the pathologic anatomy of the duodenum lends itself to that choice.
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Affiliation(s)
- T A Bowden
- Department of Surgery, Medical College of Georgia, Augusta 30912-4000
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Crofts TJ, Park KG, Steele RJ, Chung SS, Li AK. A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 1989; 320:970-3. [PMID: 2927479 DOI: 10.1056/nejm198904133201504] [Citation(s) in RCA: 151] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To determine whether surgery could be avoided in some patients with perforated peptic ulcer, we conducted a prospective randomized trial comparing the outcome of nonoperative treatment with that of emergency surgery in patients with a clinical diagnosis of perforated peptic ulcer. Of the 83 patients entered in the study over a 13-month period, 40 were randomly assigned to conservative treatment, which consisted of resuscitation with intravenous fluids, institution of nasogastric suction, and intravenous administration of antibiotics (cefuroxime, ampicillin, and metronidazole) and ranitidine. Eleven of these patients (28 percent) had no clinical improvement after 12 hours and required an operation. Two of the 11 had a perforated gastric carcinoma, and 1 had a perforated sigmoid carcinoma. The other 43 patients were assigned to immediate laparotomy and repair of the perforation. One of these patients was found to have a perforated gastric carcinoma. The overall mortality rates in the two groups were similar (two deaths in each, 5 percent), and did not differ significantly in the morbidity (infection, cardiac failure, or renal failure) rates (40 percent in the surgical group and 50 percent in the nonsurgical group). The hospital stay was 35 percent longer in the group treated conservatively. Patients over 70 years old were less likely to respond to conservative treatment than younger patients (P less than 0.05). We conclude that in patients with perforated peptic ulcer, an initial period of nonoperative treatment with careful observation may be safely allowed except in patients over 70 years old, and that the use of such an observation period can obviate the need for emergency surgery in more than 70 percent of patients.
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Affiliation(s)
- T J Crofts
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin
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38
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Abstract
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.
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Affiliation(s)
- B D Schirmer
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908
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39
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40
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Affiliation(s)
- D Johnston
- University Department of Surgery, General Infirmary, Leeds, United Kingdom
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41
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Abstract
Since August 1971, 244 highly selective vagotomies were performed for pyloric and duodenal ulceration by one surgeon (W.A.F.M.). There was one postoperative death. Twenty (8 per cent) patients were lost to follow-up. The remaining 223 patients were followed up for 1 to 14 years (mean 4.2 years). On the modified Visick grading system 83.4 per cent were Visick I or II and 16.6 per cent were Visick III or IV. The failures were mainly recurrences. The recurrence rate was 11.2 per cent. Certain factors were examined to try to elucidate those influencing recurrence rate but no significant prognostic indicator was found. Acid studies were analysed and no significant relationship between these and the development of a recurrence could be found. The second 100 vagotomies were better than the first as judged by the results of studies of insulin-stimulated acid. Finally, we question whether all recurrences should automatically be regarded as treatment failures and the patients classified as Visick IV.
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Affiliation(s)
- D J Byrne
- Airedale General Hospital, Keighley, West Yorkshire, UK
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42
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Jamieson GG. Proximal gastric vagotomy for duodenal ulcer disease--whither to now or to wither now? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1988; 58:443-6. [PMID: 3270315 DOI: 10.1111/j.1445-2197.1988.tb06233.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- G G Jamieson
- Department of Surgery, University of Adelaide, South Australia
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Primrose JN, Axon AT, Johnston D. Highly selective vagotomy and duodenal ulcers that fail to respond to H2 receptor antagonists. BMJ 1988; 296:1031-5. [PMID: 3130125 PMCID: PMC2545558 DOI: 10.1136/bmj.296.6628.1031] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A study was conducted to see whether patients with duodenal ulcers that failed to heal in response to H2 receptor antagonists had a higher incidence of recurrent ulceration after highly selective vagotomy than patients whose ulcers healed with these drugs. Between 1977 and 1983, 157 patients had a highly selective vagotomy for uncomplicated duodenal ulcer; in 57 patients the ulcer had failed to heal despite treatment with H2 receptor antagonists (refractory group), 19 patients had developed recurrent ulceration while receiving maintenance treatment, 67 patients had remained healed while taking H2 receptor antagonists but suffered frequent relapses when treatment was stopped, and 14 patients had not been given these drugs before operation. The overall incidence of recurrent ulceration was 6% after two years and 11% after five years of follow up. In the refractory group, however, the incidence of recurrent ulceration was 18% at two years and 34% after five years, whereas the incidence of recurrence was only 1.5% at two years and 3% after five years in patients whose ulcers had healed with H2 receptor antagonists. Resistance to H2 receptor antagonists was not related to preoperative basal or peak acid output but was related to cigarette smoking. Factors associated with recurrent ulceration after highly selective vagotomy were basal acid outputs before and after operation, cigarette smoking, and the surgeon who performed the operation. Duodenal ulcers that fail to respond to H2 receptor antagonists represent a more severe ulcer diathesis, for which highly selective vagotomy is less effective.
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Affiliation(s)
- J N Primrose
- University Department of Surgery, General Infirmary, Leeds
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45
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Somasundaram K, Ganguly AK. The effect of subdiaphragmatic vagotomy on the gastric mucus barrier in rats. Clin Exp Pharmacol Physiol 1987; 14:735-41. [PMID: 3442955 DOI: 10.1111/j.1440-1681.1987.tb01899.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
1. Little information exists on the quantitation of mucus barrier and its vagal control; hence, the effect of vagotomy on the two components of the mucus barrier was studied in the glandular regions of rat stomach. 2. Bilateral subdiaphragmatic vagotomy was carried out by cutting both vagus nerves at the level of the lower end of the oesophagus. After 14 days, the glycoproteins in mucosal epithelial cells were identified by periodic acid Schiff's (PAS) staining technique and were assessed by calculating the ratio of the mucosal height to that of the thickness of PAS-positive materials in it. The adherent mucus was estimated by the Alcian blue binding technique and the results were compared with control animals subjected to mock vagotomy. 3. The bilateral subdiaphragmatic vagotomy caused a significant reduction in mucosal epithelial PAS-stainable materials content in oxyntic and pyloric gland areas. 4. The operation also caused a decrease in Alcian blue binding capacity of both the glandular regions. 5. The data suggest that the absence of vagal influence causes weakening of both the lines of mucus barrier. The findings support the hypothesis that the vagal system must be intact in the rat in order to maintain gastric mucus glycoproteins and thereby mucosal integrity.
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Affiliation(s)
- K Somasundaram
- Department of Physiology, Government Medical College, Surat, India
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46
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Nielsen HO. The antral gastrin-producing cells in duodenal ulcer patients. A study of preoperative G-cell densities, fasting serum-gastrin, pre- and postoperative gastric acid secretion and outcome after parietal cell vagotomy. ACTA PATHOLOGICA, MICROBIOLOGICA, ET IMMUNOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1987; 95:99-101. [PMID: 3565011 DOI: 10.1111/j.1699-0463.1987.tb00013_95a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Antral gastrin-producing cell densities, as well as serum gastrin and gastric acid secretion were obtained prior to parietal cell vagotomy from 60 patients suffering from chronic duodenal ulcer disease. Acid secretion was also measured postoperatively. The patients were followed for five years. The ulcer recurrence rate was 20%. No differences were found in the G-cell densities, fasting serum-gastrin or gastric acid secretion preoperatively between the two groups: recurrence and non-recurrence. The acid secretion was higher postoperatively in patients with recurrent ulcer as compared to those without recurrence of the ulcer, suggesting that incomplete vagotomy is a reasonable explanation of the recurrence, even though post-operative G-cell abnormality cannot definitely be ruled out.
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Beck H. Parietal cell density before and after parietal cell vagotomy in duodenal ulcer patients. ACTA PATHOLOGICA, MICROBIOLOGICA, ET IMMUNOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1987; 95:29-33. [PMID: 3825542 DOI: 10.1111/j.1699-0463.1987.tb00006_95a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Parietal cell density, mucosal height, grade of gastritis and pentagastrin-stimulated acid production were assessed before and three months after parietal cell vagotomy (PCV) in 14 patients with duodenal ulcer. Parietal cell density was found to be unaltered after vagotomy and there was no difference in the parietal cell count in the neck and base of the glands. Both the basal acid production and the pentagastrin-stimulated acid secretion were significantly reduced after PCV. No correlation could be shown between the stimulated acid production and the parietal cell count, either pre- or postoperatively. (r = 0.14 and r = 0.19). Mucosal height and grade of gastritic changes remained unchanged. It is concluded that PCV in duodenal ulcer patients causes no change in parietal cell density assessed at three months post-operatively. Vagotomy causes no mucosal atrophy or gastritic changes within this period.
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Arigbabu AO, Omole CO, Akinola DO. Duodenal ulcer treated by highly selective vagotomy. Evaluation of experience in Nigeria. Trop Doct 1986; 16:160-3. [PMID: 3775844 DOI: 10.1177/004947558601600408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over a period of 5 years 102 highly selective vagotomies (HSV) were performed. The cases selected excluded gastric outlet obstruction. The results show a significant cure rate of peptic ulcer, without any deaths. It is suggested that the high rate of recurrences and complications reported from other centres might be due to incomplete denervation, most likely due to variations of the nerve or damage to the nerve of Latarjet, amounting to truncal vagotomy — Complete or incomplete, depending on the nature and level of damage to the nerve. From our experience at this centre, HSV has given very good clinical results in the 5 years of review. The procedure is safe and without mortality.
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Abstract
Postoperative gastric retention may be minimized by avoiding the use of the Billroth I reconstruction when a large duodenal ulcer must be retained. Postoperative gastric retention is more likely to remit with conservative therapy if the procedure was a Billroth I reconstruction with a vagotomy. In other instances where there is difficulty in gastric emptying, a mechanical cause should be strongly suspected. The optimum duration of a conservative trial with suction for postoperative gastric retention may be debatable, and contrast radiography or endoscopy may be helpful; however, patience and suction are not long-term substitutes for a needed operation.
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50
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Abstract
From January 1973 through December 1979, 131 patients underwent proximal gastric vagotomy (PGV) for duodenal ulcer. There were 78 men and 53 women, whose age ranged from 19 to 73 years, with a mean age of 45 years. One hospital death occurred as a result of pulmonary embolism (0.7% mortality). There were 12 late deaths unrelated to ulcer disease, and each of the 12 patients was graded Visick I or II prior to death. Nine patients were lost to follow-up. This report is an analysis of the remaining 109 patients followed from 6 to 13 years. One hundred two patients (93.5%) underwent PGV for intractability. Seven patients (6.5%) who underwent PGV in selective circumstances for either acute perforation (3 patients), bleeding (1 patient), and moderate outlet obstruction (3 patients) are included. Follow-up results reveal that 52 patients (47%) are graded Visick I, 40 patients (36%) Visick II, five patients (5%) Visick III, and 12 patients (12%) Visick IV. Mild diarrhea occurred in 2.8% and mild dumping in 1.9%, and no reflux gastritis or esophagitis was noted. Recurrent ulceration took place in 10 patients, and seven subsequently required reoperation. Two additional patients had the antral pump mechanism denervated and later required antrectomy. PGV has yielded satisfactory results over a 6-13 year follow-up when operation was done for intractability. The low incidence of unpleasant long-term side effects is an appealing feature of the operation. A recurrent ulcer rate of 9.2% (10 patients) has, however, been of major concern. Those with a prime interest in gastric surgery are urged to continue the use of PGV in cases of intractability. Another 10 years of clinical investigative work will no doubt be necessary to determine the ultimate rate of recurrent ulceration.
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