- 作者：Janaka Lagoo ; Theodore N. Pappas ; Alex ; er Perez
- 关键词：Peptic ulcer disease ; Vagotomy ; Selective vagotomy ; Highly selective vagotomy ; Truncal vagotomy ; Proton pump inhibitors
- 刊名：The American Journal of Surgery
- 出版年：January, 2014
- 年：2014
- 卷：207
- 期：1
- 页码：120-126
- 全文大小：216 K
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.