Vagotomy
Vagotomy is a surgical procedure that involves the severing of the vagus nerve, which is responsible for regulating various bodily functions, including digestion and gastric acid secretion. This procedure is primarily performed as a treatment for chronic acid reflux and peptic ulcers, which can cause significant discomfort and potential complications if left untreated. The vagus nerve's role in stimulating gastric acid production means that cutting it can effectively reduce acid secretion, helping to alleviate the symptoms associated with these conditions.
Due to the vagus nerve’s involvement in peristalsis, or the movement of food through the digestive tract, vagotomy is often combined with additional surgical techniques, such as gastroenterostomy or pyloroplasty. These procedures facilitate the passage of food from the stomach into the small intestine, ensuring that digestion continues smoothly despite the loss of normal nerve function. The specific approach to vagotomy may vary depending on the location of the ulcer, with particular branches of the nerve targeted accordingly. Recovery from vagotomy typically mirrors that of general surgical procedures, involving pain management and a gradual reintroduction of food. This surgical intervention provides a significant option for individuals suffering from debilitating digestive issues.
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Subject Terms
Vagotomy
Anatomy or system affected: Gastrointestinal system, nerves, nervous system, stomach
Definition: The surgical cutting of the vagus nerve or nerves as part of the treatment for gastric ulcers.
Indications and Procedures
The vagus nerves, the longest nerves in the body, pass from the head through the neck, chest, and abdominal regions. They regulate such processes as speech, coughing, swallowing, heart rate, and hunger sensation. Branches of the vagus nerve also stimulate gastric acid secretions and gastric movements.
Vagotomy is generally carried out in conjunction with treatments for gastric (stomach) and duodenal (intestinal) ulcers. Such peptic ulcers are characterized by the loss of mucous membranes in regions exposed to such stomach secretions as hydrochloric acid and the digestive enzyme pepsin. Mild ulcers may heal on their own, but chronic ulceration may result in significant damage or scarring to the stomach or intestinal wall. In addition to the pain and discomfort associated with an ulcer, under some circumstances, the ulcer may become cancerous. While the formation of peptic ulcers is poorly understood, it is known that acid secretion by the stomach can aggravate the condition.
Since the vagus nerve serves to stimulate acid secretions by the parietal cells of the stomach, cutting the nerve is an effective way to reduce such secretions. Since cutting the vagus nerve will also reduce or eliminate peristalsis, the rhythmic contraction of muscle that forces food through the stomach, additional procedures are often carried out in combination with a vagotomy. For example, an artificial opening between the stomach and small intestine may be created (gastroenterostomy) to allow the food to move directly from the stomach to the intestine without needing stomach peristalsis. An alternative to gastroenterostomy is a pyloroplasty, an operation on the pylorus or gastric outlet that allows food to move through the digestive system.
The specific region of the vagus nerve on which the vagotomy will be carried out depends on the site of the ulcer. For example, in the case of a duodenal ulcer, the most common form of ulcer, the branch innervating the parietal area of the stomach, is severed, reducing the amount of acid produced by the cells in that outer portion of the stomach. Recovery is similar to that of any other general surgical procedure. Medication is provided for pain, and food is reintroduced gradually.
Bibliography
Abrahams, Peter H., Sandy C. Marks, Jr., and Ralph Hutchings. McMinn’s Color Atlas of Human Anatomy. 6th ed. St. Louis, Mo.: Mosby/Elsevier, 2008.
Baron, J. H., et al., eds. Vagotomy in Modern Surgical Practice. Boston: Butterworths, 1982.
Margolis, Simeon, and Sergey Kantsevoy. Johns Hopkins White Papers 2002: Digestive Disorders. New York: Rebus, 2002.
Monroe, Judy. Coping with Ulcers, Heartburn, and Stress-Related Stomach Disorders. New York: Rosen, 2000.
Tortora, Gerard J., and Bryan Derrickson. Principles of Anatomy and Physiology. 13th ed. Hoboken, N.J.: John Wiley & Sons, 2012.
“Vagotomy: Types, Uses, Definition & Procedure.” Cleveland Clinic, 21 June 2022, my.clevelandclinic.org/health/treatments/23390-vagotomy. Accessed 21 July 2023.
Zollinger, Robert M., Jr., Robert M. Zollinger, Sr., et al. Zollinger’s Atlas of Surgical Operations. 9th ed. New York: McGraw-Hill, 2011.