What is a truncal vagotomy?
A truncal vagotomy is the division of the anterior and posterior trunks 4-cm proximal to the GEJ. Removes the acetylcholine-mediated secretion of acid from parietal cells. Results in the accelerated emptying of liquids due to the removal of the vagally mediated receptive relaxation of the gastric fundus.
Why is truncal vagotomy done?
Truncal vagotomy. This type is commonly used with pyloroplasty or abdominal drainage to treat chronic peptic ulcers. It involves cutting one or more of the branches that split off the main trunk of the vagus nerve and travel down your esophagus to your stomach and other digestive organs.
Why it is called criminal nerve of Grassi?
The right (posterior) vagus gives rise to a posterior gastric branch called the criminal nerve of Grassi—so called because it is often missed during vagotomy and is then responsible for the recurrence of PUD—which traverses to the left and supplies the cardia and the fundus.
Why does dumping syndrome occur after vagotomy?
Alterations in the gastric anatomy after surgery or interference in its extrinsic innervation (vagotomy) may have profound effects on the gastric reservoir and pyloric sphincter mechanism and, in turn, alter gastric emptying. These effects, for convenience, have been termed postgastrectomy syndromes.
How does vagotomy cause diarrhea?
However, vagotomy often also damages branches of the vagus nerve innervating the liver and gallbladder. This leads to gallbladder distension and secretion of excess bile salts. This triggers diarrhoea.
What are the side effects of a vagotomy?
Vagotomy Side Effects
- Cholestasis, or the stopping or slowing of bile in the gallbladder.
- Delayed gastric emptying.
- Dumping syndrome.
- Weight loss.
- Injury to the stomach, esophagus, and/or major blood vessels during surgery.
What is cut in highly selective vagotomy?
Highly selective vagotomy divides the terminal branches of the anterior and posterior vagus (Latarjet nerves) along the lesser curvature of the stomach, from 5–6 cm distal to the cardia to 6 cm from the pylorus. These nerves run in the anterior and posterior leaves of the lesser omentum.
Why is the nerve of Latarjet?
It is cut in selective vagotomy and preserved in highly selective vagotomy. It functions by increasing peristalsis and relaxing the sphincter, thus draining the contents of the stomach into the first part of duodenum. If damage occurs to this nerve, it can cause retention syndrome.
What foods should you avoid with dumping syndrome?
Avoid simple sugars such as sweets, candy, soda, cakes, and cookies. Avoid foods that are very hot or very cold. These can trigger dumping syndrome symptoms. Do not drink liquids with your meal.
Why is it called dumping syndrome?
Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly.
What is the prevalence of truncal vagotomy with diarrhea?
Truncal vagotomy is associated with clinically significant diarrhea in 5% to 10% of patients. It occurs soon after surgery and usually is not associated with other GI or systemic symptoms, a fact that helps to distinguish it from dumping.
Truncal Vagotomy A truncal vagotomy is the division of the anterior and posterior trunks 4-cm proximal to the GEJ. Removes the acetylcholine-mediated secretion of acid from parietal cells Results in the accelerated emptying of liquids due to the removal of the vagally mediated receptive relaxation of the gastric fundus
What are the possible complications of truncal vagotomy after distal gastrectomy?
Reconstruction after distal gastrectomy includes gastroduodenostomy (Billroth I), gastrojejunostomy (Billroth II), and the Roux-en-Y gastrojejunostomy. Abdominal wall and skin closure Complications The major immediate and intraoperative complications specific to truncal vagotomy include death, bleeding, and injury to the stomach or esophagus.
Does a history of truncal vagotomy reduce the risk of Parkinson’s disease?
Therefore, a history of truncal vagotomy does not provide a significant risk reduction for the development of PD even at 20-year follow-up.