Proximal Gastric Vagotomy: Does It Have a Place in the Future Management of Peptic Ulcer?

Proximal gastric vagotomy (PGV) is a modification of truncal vagotomy, which was introduced by Dragstedt for the treatment of duodenal ulcer (DU) in 1943. It is a technically demanding operation; but when performed by an experienced surgeon, it is safe and gives a cure rate for DU of more than 90%,...

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Bibliographic Details
Published in:World journal of surgery 2000-03, Vol.24 (3), p.259-263
Main Author: Johnson, Alan G.
Format: Article
Language:English
Subjects:
Duodenal Ulcer - microbiology
Duodenal Ulcer - surgery
Helicobacter Infections - complications
Helicobacter Infections - prevention & control
Helicobacter pylori
Humans
Nerve Regeneration
Peptic Ulcer - microbiology
Peptic Ulcer - surgery
Vagotomy, Proximal Gastric
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Summary:Proximal gastric vagotomy (PGV) is a modification of truncal vagotomy, which was introduced by Dragstedt for the treatment of duodenal ulcer (DU) in 1943. It is a technically demanding operation; but when performed by an experienced surgeon, it is safe and gives a cure rate for DU of more than 90%, with minimal side effects. The operation permanently alters the natural history of the disease and may be used for gastric ulcer (GU), with ulcer excision; but it is not as effective. Further adaptations, such as posterior truncal vagotomy with anterior seromyotomy, were introduced to simplify and shorten the operation, but they did not receive wide acceptance. Recently, with the identification of Helicobacter, it was found that DU can also be cured by eliminating the infection. PGV is therefore used electively in patients with persistent DU that is not Helicobacter‐positive or in the few in whom Helicobacter cannot be eliminated. In patients with bleeding or perforated DUs, PGV may be used in conjunction with underrunning the vessel or patching the perforation. However, few surgeons doing emergency peptic ulcer surgery have experience with PGV, so simple suture followed by medical treatment is the safest option. Because elective PGV is now a rare procedure, patients should be referred to a center with special expertise. If Helicobacter becomes resistant to antibiotics in the future, surgery may be needed regularly again, but the technical nuances would have to be relearned.
ISSN:0364-2313
1432-2323
DOI:10.1007/s002689910042