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Results for “Vagotomy, Truncal”

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At least 19 recordsLinked to original sources
PubMed1975

Canine gallbladder bile. Effects of proximal gastric vagotomy, truncal vagotomy, and truncal vagotomy with pyloroplasty on volume and composition.

Three groups of four dogs each underwent proximal gastric vagotomy, truncal vagotomy, or truncal vagotomy with pyloroplasty. Two dogs had sham operations. Gallbladder bile was aspirated and measured. Aliquots were cultured and assayed for cholesterol, phospholipid, and bile salts initially and at subsequent laparotomies. Both truncal vagotomy groups showed marked increases in aspirate volume at subsequent laparotomies. The sham and proximal gastric vagotomy groups showed a small initial decrease in mean aspirate volume without further significant changes. When the bile assay data were plotted on triangular coordinates, all point for all groups remained well within the area of cholesterol solubility. Nevertheless, two dogs in each truncal vagotomy group were found to have gallstones. No stones were found in the sham and proximal gastric vagotomy groups. Proximal gastric vagotomy appears to preserve fasting gallbladder bile volume and does not alter bile composition in the dog.

Animals↗
PubMed1978

Fasting and postprandial serum gastrin levels before and after highly selective gastric vagotomy, truncal vagotomy with pyloroplasty and truncal vagotomy with antrectomy: is there a cholinergic antral gastrin inhibitory and releasing mechanism?

Fasting serum gastrin levels and postprandial gastrin response were measured before and 1 month after highly selective vagotomy, truncal vagotomy with pyloroplasty and truncal vagotomy with antrectomy. The three groups of patients, 12 in each group, were closely matched for age, sex, maximum acid output and completeness of vagotomy. After highly selective and truncal vagotomy an identical and significant increase in fasting gastrin was observed, whereas after truncal vagotomy with antrectomy the pre- and postoperative fasting gastrin levels were not different. The net postprandial gastrin output over basal value was significantly increased after highly selective vagotomy, unchanged after truncal vagotomy and significantly lowered after truncal vagotomy with antrectomy. These results suggest the presence in the intact subject of a cholinergic inhibitory mechanism in the gastric body and fundus for the release of antral gastrin in the fasting and postprandial states and a possible cholinergic facilitatory mechanism for the release of antral gastrin after meals.

Clinical Trials as Topic↗
PubMed1983

Proximal gastric vagotomy, truncal vagotomy with drainage, and truncal vagotomy with antrectomy for chronic duodenal ulcer. A prospective, randomized controlled trial.

The relative merits of proximal gastric vagotomy (PGV), truncal vagotomy with drainage (TV + D), and truncal vagotomy with antrectomy (TV + A) in the treatment of chronic duodenal ulcer were evaluated and compared in 152 patients in a prospective, randomized and controlled clinical trial. One death occurred after TV + A, resulting in an operative mortality of 2% after gastrectomy and 0.7% for the entire series. After one to six years, stomal and duodenal ulcers proven by endoscopy occurred in eight patients after PGV (16%) and in six patients after TV + D (11.8%); the difference was not statistically significant (p greater than 0.5). One additional patient developed a gastric ulcer nine months after PGV. There was so far no ulcer recurrence after TV + A. Majority (13 patients) of the recurrent ulcers were discovered within three years after surgery. Patients after PGV experienced significantly less unwanted side effects than those after either TV + D or TV + A; particularly, dumping, epigastric fullness, and diarrhea. When the functional status was graded according to a modified Visick system that excluded ulcer recurrence, significantly more PGV patients were placed in the near-perfect grade (82.1%) than TV + A patients (58%). Patients after TV + D fared better than patients after TV + A; but the differences were not significant. However, when ulcer recurrence was included in the functional assessment, the advantage of PGV was lost.

Chronic Disease↗
PubMed1990

Anterior lesser curve seromyotomy and posterior truncal vagotomy versus truncal vagotomy and pyloroplasty in the treatment of chronic duodenal ulcer.

In a prospective randomized controlled clinical trial, anterior lesser curve seromyotomy with posterior truncal vagotomy (AMPT, n = 77) has been compared with truncal vagotomy and pyloroplasty (TVP, n = 69) in 146 patients with chronic duodenal ulcer with a mean duration of symptoms of 7 years. The mean follow-up time was 4.5 years with a range of 2-7 years. One elderly patient died from a myocardial infarction in the TVP group. Acid secretory inhibition in response to insulin and pentagastrin stimuli was equal in both groups, indicating a similar degree of vagal denervation. Recurrent ulcers were more common after AMPT (five) than TVP (two) (P = 0.29, n.s.). Dumping and diarrhoea were significantly commoner (P less than 0.001) after TVP, with 31 instances as opposed to eight with AMPT. The mean operating time was increased by 6 min when AMPT was performed rather than TVP. The results of this study have shown that AMPT is associated with a lower incidence of dumping and diarrhoea and achieves better overall Visick grading. However, continued monitoring is required to assess the long-term incidence of recurrent ulceration after this procedure.

Adult↗
PubMed1984

The concentrating function of the feline gallbladder after truncal vagotomy.

Truncal vagotomy is associated with a raised incidence of cholesterol gallstone disease and increase in the size of the gallbladder and of the bile acid pool. Investigations of hepatobiliary function in man and mammals after truncal vagotomy have not established if the enlarged gallbladder is simply dilated, or if the absorptive capacity of the mucosa has changed. We studied the concentrating function of the gallbladder with a perfusion technique in anaesthetized cats three weeks and three months after intrathoracic truncal vagotomy and compared the results with a control group. The histology of the gallbladder was studied with light microscopy. Three weeks after vagotomy the gallbladder size, histologic picture and concentrating function did not differ from observations in the control cats. Three months after the vagotomy the gallbladder was slightly enlarged, sludge was found in the luminal contents, an inflammatory response was seen in the mucosa and the net rate of water absorption was increased two to three times compared with the controls. Possible mechanisms in the increased rate of net water absorption are tentatively discussed.

Animals↗
PubMed1979

Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy.

In a prospective study of proximal gastric vagotomy and truncal vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gastric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vagotomy and antrectomy reduced the intergrated gastrin output after either meal. Proximal gastric vagotomy (PGV) produced rapid early emptying of the liquid meal with no alteration in the early emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. In preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PGV to reduce the hypergastrinaemia produced by the operation.

Clinical Trials as Topic↗
PubMed1979

Effect of proximal gastric vagotomy and truncal vagotomy and pyloroplasty on gastric functions and growth in puppies after massive small bowel resection.

The effects of truncal vagotomy and pyloroplasty and proximal gastric vagotomy on gastric acid hypersecretion, hypergastrinemia, and growth after massive bowel resection were studied in beagle puppies. In puppies with 80% enterectomy, neither type of vagotomy alters significantly the postprandial hypersecretion of acid from the Heidenhain pouch or the concentration of serum gastrin. Proximal gastric vagotomy tended to decrease the hypersecretion more than did truncal vagotomy. In beagle puppies undergoing 70% small bowel resection, growth was significantly decreased but survival was not impaired. Neither proximal gastric vagotomy nor truncal vagotomy and pyloroplasty reversed completely the impaired growth produced by massive resection. Proximal gastric vagotomy caused a small improvements in growth, while truncal vagotomy and pyloroplasty resulted in a slight decrease in growth. It remains possible that proximal gastric vagotomy could be of value in the management of growing infants with hypersecretion of acid due to short bowel syndrome.

Animals↗
PubMed1995

[Laparoscopic selective vagotomy (posterior truncal vagotomy and anterior linear stomach resection) in complicated duodenal ulcer].

32 patients with complicated duodenal ulcer (bleeding, recurrence, perforation) were treated by laparoscopic posterior truncal vagotomy and anterior linear gastric resection in our modification (access to the posterior vagus via the omental bursa) of the method of Gomez-Ferrer/Taylor. Instead of the seromyotomy along the lesser curve we resect a 1 cm broad strip out of the anterior gastric wall. In one patient with additional hiatus hernia the anterior vagal trunc was cut accidentally. Converted to laparotomy this case was completed as truncal vagotomy and pyloroplasty. No disorders of postoperative gastric emptying were found. 17 patients were followed up 6 weeks postoperatively. 14 showed complete healing of the ulcer, 2 patients showed healing in progress. A follow up after 12 months obtained information about 18 patients: 7 were free of symptoms, 11 complained about intermittent pains or fullness. 8 of these 11 patients were controlled by gastroscopy, not any ulcer or gastritis or disorder of gastric emptying could be found. We see advantages of our method over Kathkouda's modification of Taylor's procedure in the simplicity of the method, the primary hemostasis and a short operating time by using the stapler. We consider our procedure a minimal invasive, quick, safe treatment for duodenal ulcer disease with lasting effect at reasonable cost, especially in complicated cases like recurrent ulcer, bleeding or penetrating ulcer and in noncompliant patients that are not suitable for medical treatment.

Adult↗
PubMed1990

Comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty: results at 8-15 years.

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.

Adult↗
PubMed1989

Parietal cell vagotomy and truncal vagotomy in elective duodenal ulcer surgery--results after six to twelve years.

In a randomized trial between 1974 and 1980, parietal cell vagotomy (PCV) was compared with truncal vagotomy (TV) in the treatment of duodenal ulcer in 106 patients. After a mean period of 3.9 years no significant differences were found between PCV and TV patients with respect to Visick grading and recurrence rates. Nor did the preoperative location of the ulcer-prepyloric or duodenal-significantly influence the recurrences. The latter follow-up reported in 1981, showed that PCV was not superior to TV. The present paper describes a re-analysis of the same material in 1985. After a mean observation time of 8.7 years no significant differences in the ulcer recurrence rate were found between PCV and TV. Equal patient satisfaction with the two procedures was found. In patients with prepyloric ulcers, preoperatively, there was a higher recurrence rate among those who had undergone PCV than TV.

Duodenal Ulcer↗
PubMed1978

Highly selective vagotomy or truncal vagotomy and pyloroplasty for chronic duodenal ulceration: a randomized, prospective clinical study.

The results of a randomized, prospective clinical trial of highly selective vagotomy (HSV) versus truncal vagotomy and pyloroplasty (TVP) in 126 male patients undergoing elective surgery for chronic duodenal ulceration are presented. The operations were performed by surgeons of all grades of experience. At a mean follow-up time of just over 3 years a satisfactory result was obtained in 93 per cent of patients following HSV and 78 per cent of patients following TVP, the difference being probably statistically significant (P less than 0.05). The incidence of early and late dumping, bile vomiting, flatulence, post-prandial epigastric discomfort and wound infection was statistically significantly less after HSV than after TVP. Three patients have developed a recurrent duodenal ulcer after each type of operation (5.4 per cent). At this early stage HSV has advantages over TVP; it will be interesting to see if these are maintained with the passage of time.

Adult↗
PubMed1983

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: results after 5-7 years.

In a prospective, randomized study 145 patients with duodenal ulcer have been followed 5-7 years after proximal gastric vagotomy (PGV) or truncal vagotomy with antrectomy (TVA). Postoperative complications were significantly higher after TVA (P less than 0.0005). There was one death due to anastomotic leakage after TVA. The recurrence rate was significantly higher after PGV (9.9 per cent). Postoperative symptoms were less after PGV (P less than 0.01). Due to the recurrence rate after PGV there was no overall significant difference in the Visick grading, although perfect results (Visick I) were seen significantly more often (P less than 0.01). It is concluded that better results follow PGV.

Body Weight↗
PubMed1979

Highly selective vagotomy and truncal vagotomy and pyloroplasty for duodenal ulcer: a clinical review.

A review was conducted of the operations of highly selective vagotomy (HSV) and truncal vagotomy and pyloroplasty (TVP) performed for peptic ulcer disease. Gastric acid output was reduced equally after both procedures: basal acid output was reduced by 80% and maximal acid output by 50% to 60%. Not surprisingly, therefore, the recurrence rates were similar (6.6% after HSV compared to 5.6% after TVP). However, the mortality following HSV was 0% compared with 0.7% after TVP. The incidence of all side effects was lower following HSV, so that the results in 86% of patients who underwent this operation were considered excellent or very good (Visick grades I and II). The authors conclude that HSV should be considered the primary conservative procedure in the surgical management of peptic ulcer disease.

Duodenal Ulcer↗
PubMed1994

Meta-analysis of highly selective vagotomy versus truncal vagotomy and pyloroplasty in the surgical treatment of uncomplicated duodenal ulcer.

OBJECTIVE: To compare critically by meta-analysis the postoperative outcomes after truncal vagotomy and pyloroplasty (TVP) and after highly selective vagotomy (HSV). DATA SOURCES: A search was conducted on MEDLINE with the keywords "peptic ulcer" and "vagotomy". Bibliographics of the articles retrieved and review articles pertaining to the subject were scanned further. STUDY SELECTION: Included were only published prospective, randomized controlled trials comparing TVP and HSV in the English-language literature up to April 1991. Twelve studies were found. DATA EXTRACTION: Two authors, working independently, abstracted raw data on mortality, recurrence, dumping, diarrhea and postoperative Visick grading. DATA SYNTHESIS: A ratio greater than 1.0 indicates a higher proportion occurring with TVP and less than 1.0 a higher proportion with HSV. [Table: See Text] CONCLUSION: The results suggest that the likelihood of adverse long-term sequelae is higher with TVP whereas the likelihood of recurrence is higher with HSV.

Confidence Intervals↗
PubMed1981

The effect of a parietal cell vagotomy and truncal vagotomy with and without drainage on duodenal ulcers in the rat.

The gastric secretagogues, pentagastrin and carbachol, produced a 100% incidence of duodenal ulcers. Truncal vagotomy (TV) and parietal cell vagotomy (PCV) prevented these experimental ulcers in the early post-operative period. At 3 weeks TV rats showed a decrease in weight gain, gross gastric distension and the infusion of gastric secretagogues now caused hypersecretory-induced gastric ulcers. TV and gastroenterostomy rats developed stomal ulceration and PCV failed to prevent formation of duodenal ulcers at 3 weeks. These results indicate that vagotomy, irrespective if truncal or highly selective, only has a temporary effect. This may be due to ischaemia or an altered sensitivity of the parietal cell mass with a post-operative recovery.

Animals↗
PubMed1978

Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: interim results.

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastrict vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4.3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups-6 after PGV, usually for recurrent ulcer, and 7 after TVA, mostly for gastric retention. PGV showed a marked superiority in the number of patients with a good clinical result Visick I or II) at 1 year after operation, i.e. 82 per cent compared with 56 per cent for TVA.

Chronic Disease↗
PubMed1983

A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty--one surgeon's results after 5 years.

In a prospective randomized trial highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP). One surgeon performed all the operations. Ninety-eight per cent of patients were reviewed by two physicians after 20-97 mth (mean 61 mth). Fifty-nine of 68 patients (87 per cent) had an excellent or very good result after HSV (Visick grades I and II) compared with 48 of 69 (70 per cent) after TVP (P less than 0.05). There was 1 proven recurrence after HSV and 4 after TVP. Diarrhoea, including mild symptoms, occurred in 5 patients (7 per cent) after HSV and in 27 (39 per cent) after TVP (P less than 0.001). Severe diarrhoea did not occur after HSV but was present in 4 patients (6 per cent) after TVP (P less than 0.001). Flatulence, epigastric fullness and weight loss were also significantly more common after TVP. On average HSV took 72 min to perform compared with 44 min for TVP (P less than 0.001). Transient dysphagia occurred in 19 patients after HSV compared with 8 after TVP (P less than 0.05). HSV gave better results than TVP and was associated with a low recurrence rate (1.5 per cent at a mean of 5 yr). Although technically more demanding, HSV in our hands is a better operation than TVP for uncomplicated duodenal ulcer.

Adult↗