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Park JH, Lee J, Kim DH, Min JS, Kim TH, Jung EJ, Park T, Jang JY, Woo JW, lee HS, Park M, Jeong SH. Concurrent laparoscopic highly selective vagotomy with closure of duodenal ulcer perforations show good clinical results as primary repair alone. J Int Med Res 2023; 51:3000605231206319. [PMID: 37890147 PMCID: PMC10612450 DOI: 10.1177/03000605231206319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/08/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To compare clinical and operative results between laparoscopic primary repair (LPR) alone and LPR with highly selective vagotomy (LPR-HSV) in patients with duodenal ulcer perforation. METHODS Clinical data from patients who underwent either LPR or LPR-HSV by resecting both sides of the neurovascular bundle using an ultrasonic or bipolar electrosurgical device for duodenal ulcer perforations, between 2010 and 2020, were retrospectively collected. Between-group differences in continuous and categorical variables were statistically analysed. RESULTS Data from 184 patients (mean age, 49.6 years), who underwent either LPR (n = 132) or LPR-HSV (n = 52) were included. The mean operation time was significantly longer in the LPR-HSV group (116.5 ± 39.8 min) than in the LPR group (91.2 ± 33.3 min). Hospital stay was significantly shorter in the LPR-HSV group (8.6 ± 2.6 days) versus the LPR group (11.3 ± 7.1 days). The mean postoperative day of starting soft fluid diet was also significantly shorter in the LPR-HSV group (4.5 ± 1.4 days) than in the LPR group (5.6 ± 4 days). No between-group difference in morbidity rate was observed. The learning curve of the HSV procedure showed a stable procedure time after 10 operations. CONCLUSIONS LPR with HSV may be a safe and feasible procedure for selective cases who are at high risk for ulcer recurrence.
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Affiliation(s)
- Ji-Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin‑Kwon Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong-Hwan Kim
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Centre, Busan, Republic of Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Han Shin lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Miyeong Park
- Department of Anaesthesiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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