When a peptic ulcer occurs, the acidity of the secreted gastric juice increases. This condition is quite dangerous and leads to serious health problems. An ulcer can progress, so with the appearance of this pathology, experts recommend performing an operation called vagotomy. This is a surgical procedure in which the vagus nerve fibers are excised, resulting in stimulation of the production of hydrochloric acid.
Vatogomy and pyloroplasty
It is worth considering in more detail the features of surgical intervention. Vagotomy is an operation in which a vagus (vagus nerve) is excised. Pyloroplasty is a surgical procedure in which the diameter of the pylorus increases (the area in which the stomach passes into the duodenum). Thanks to this, it is possible to improve the process of gastrointestinal release. Very often, these two operations are performed jointly.
As a rule, these procedures are prescribed if the patient suffers from a chronic degree of duodenal ulcer or in case of exacerbation of the pathology. Also, vagotomy is the only treatment if more than 2 years no other therapeutic measures bring a visible result.
It is worth noting that an ulcer of this type manifests itself in the form of rather unpleasant symptoms. Patients develop standard dyspeptic symptoms that manifest as nausea, vomiting, heartburn, and belching. Additionally, bloating and problems with stools may appear. This is due to the fact that in the human body there is a violation of the basic nervous and hormonal mechanisms.
This can happen amid numerous factors. Many people think that only those people who consume too much alcohol are affected by the ulcer. However, a similar pathology can develop against the background of malnutrition or with an upset of the endocrine system.
It is also worth paying attention to the fact that the level of hydrochloric acid content also depends on the innervation to which the vagus nerve leads. It can also negatively affect organ motility. When excising the entire nerve or its individual branches, it becomes possible to normalize the amount of secreted hydrochloric acid, so that the pathology can be cured by reducing the aggressive effects of gastric juice.
If the patient is diagnosed with obstruction of the duodenum 12, then in this case, you can not do without a resection of the stomach, in which the so-called workaround will be established.
Who is shown the operation
Vagotomy is a procedure that is not always recommended. As a rule, an operation is performed if the patient suffers from:
- Non-healing people, even taking into account the course of conservative therapy, peptic ulcers.
- Too frequent relapses of the disease.
- The occurrence of ulcers of the gastrointestinal tract after surgery.
- Reflux esophagitis.
- Hernia of the esophagus .
Also, vagotomy with pyloroplasty can be recommended if the patient is diagnosed with an ulcer not only in the duodenum 12, but also in the stomach. Therefore, the procedure is often performed for stenosis, perforation, and bleeding.
However, before surgery, it is necessary to undergo all necessary examinations and consult with a specialist on the feasibility of such events.
Contraindications
There are several situations in which gastric vagotomy cannot be performed. For example, performing such an operation is prohibited if the patient suffers from:
- Chronic diseases that can affect various organs and systems that are in a state of decompensation.
- Acute infectious pathologies.
- Obesity.
- Oncological diseases.
- Atony of the intestine.
- Diabetes mellitus.
- Clotting pathology.
Preparatory procedures
Before performing a vagotomy of the stomach, it is necessary to prepare for such a procedure. In this case, no special requirements and preparatory procedures are required. A vagotomy is performed in the same way as other types of surgical intervention performed on the digestive tract. This type of procedure is performed under general anesthesia.
However, despite the fact that this type of surgical intervention is not a complicated operation, the patient must undergo a laboratory examination before performing it. First of all, a complete biochemical analysis of blood and urine is performed. Additionally, it is necessary to check the level of coagulability of the liquid. There should be no surprises during the operation. Therefore, additional instrumental manipulations are also performed. It is necessary to undergo an ECG, X-ray of the lungs and other areas, if the doctor has a suspicion that the patient may suffer from various pathologies.
It will not be superfluous to additionally examine the entire digestive system. This is necessary in order to exclude the opening of nodes during the operation (vagotomy), which may complicate the procedure. As a rule, fibrogastroduodenoscopy is preliminarily performed for this purpose. Thanks to this examination, it becomes possible to assess the secretory and motor function, as well as the condition in which the mucous membrane of the organs is located.
In some situations, an X-ray examination is performed, during which a special contrast agent is introduced into the patient’s stomach. In the resulting image, the specialist accurately determines not only the location of the lesion, but also the depth of the ulcer.
With the help of PH-metry, it becomes possible to clarify the acidity level of juices secreted into the stomach. After surgery, a similar study is repeated. The doctor compares the levels of indicators. It becomes possible to dynamically control data before and after surgery. Thanks to these data, you can evaluate how effective the operation is.
Types of vagisection of the stomach
Today, there are several types of such procedures. Each variety has its own characteristics. The choice of this or that type of vagotomy is carried out by the doctor. The specialist studies in detail the patient’s medical history, state of health, and many other features. He must make sure that during or after the operation, the person will not suffer from serious complications.
Based on the data obtained, the patient may be assigned to a stem vagotomy, selective (selective) or selectively proximal.
In the first case, we are talking about a procedure in which a vaginal trunk is excised in an area located above the diaphragm, to the point where the veins branch into smaller processes. Due to this, it becomes possible to remove inflammation simultaneously from several organs of the digestive system. In addition, in the process of stem vagotomy, this nerve loses its innervation, against the background of which desynchronization of the affected organs occurs. First of all, this, of course, applies to the stomach.
First, the surgeon must isolate and excise the anterior and posterior branch of the vagus nerve. Typically, the procedure begins with the anterior trunk, which innervates the liver and stomach. After that, the surgeon moves to the back of the nerve trunk, which is located behind the esophagus. This part is responsible for the innervation of the intestines and pancreas. If necessary, a trunk vagotomy with pyloroplasty can be performed. In this case, the gatekeeper will be additionally increased.
If we talk about the selective type of procedure, then it is somewhat different from the previous method. In the process of selective vagotomy, small nerve branches that go to the stomach are excised. Manipulations are carried out in this case below the diaphragm. With this procedure, it is possible to maintain the innervation of the organs entering the digestive system.
However, most often, doctors perform selective proximal vagotomy. During this surgical procedure, nerve fibers are excised, which are sent to the upper part of the stomach. In this case, it is possible to maintain the evacuation function of the affected organ. This makes selective-proximal vagotomy the most optimal solution. Such an operation is most often prescribed if the patient suffers from constant relapses of peptic ulcer.
In a highly selective procedure, only vagal fibers are excised, which are responsible for the nutrition of acid-forming cells.
Methods of performing an operation
Today, surgery uses the so-called open access (laparotomy), which is more traumatic, and an endoscopic option.
If we talk about the method of excision of nerve fibers, then can be used as a surgical instrument (scalpel), and the method of medical-thermal effects (coagulation). If the doctor prefers the second method, then the vagus nerve branch is devastating with the help of special medications (for example, it can be an alcohol-cocaine hyperion mixture).
In addition, there is a combined method. In addition to standard tools, experts use chemical solutions. Such a variation of the procedure is considered optimal, since in this case it is possible to minimize injuries of the internal cavities of the body. However, this method has one drawback. The fact is that such a procedure takes more time. The operation takes 10-20 minutes longer.
It should be borne in mind that during a standard operation, during which tools are used, it is necessary to monitor the level of acidity of gastric juices. Without this, it is very difficult to assess the completeness of the ongoing denervation.
However, it should be borne in mind that even when conducting the most gentle and effective procedure, there remains a high risk that problems with the acidity of the gastric juice will appear again. According to statistics, in 50% of cases, patients are diagnosed with relapse of peptic ulcer. However, the ailment returns after a rather long time. Therefore, it is still possible to temporarily alleviate the condition of the patient.
Disadvantages of the procedure
If the treatment of peptic ulcer is carried out using vagotomy, then you need to know that in this case the parasympathetic innervation will be impaired. This negatively affects not only those areas where acidity is increased, but also in other organs of the gastrointestinal tract.
4% of the operated patients subsequently showed not only relapses of the pathology, but also serious problems of the motor-evacuation functions of the stomach. This means that such a procedure may well lead to the fact that the patient will suffer from severe form of diarrhea, which will also require surgical intervention. Therefore, deciding on an operation, preference should be given to selective-proximal vagotomy for peptic ulcer. In this case, there is a much greater chance of avoiding such complications.
If we are talking about a stem type procedure, then in this case other additional problems may appear. For example, many patients were faced with the fact that a few years after surgery, they found stones in the gallbladder.
Additionally, the so-called complex symptom complex may occur. In this case, patients who underwent surgery complain of increased weakness, heart palpitations. After eating, indigestion may begin.
Some have duodeno-gastric reflux. This means that the contents of the duodenum begin to be thrown back into the stomach. This leads to very unpleasant symptoms. Patients experience abdominal pain, vomiting of bile, a constant feeling of bitterness in the oral cavity and rapid weight loss.
Length of hospitalization
If the operation was carried out in the usual way using tools, then after the procedure, stitches are applied. The patient should be at rest and move as little as possible. After about a week, the stitches are removed. However, after this, for 1-2 weeks, the patient should remain in the hospital under the supervision of a doctor. This is a rather long period, especially considering that after discharge the patient will have a long recovery period. Full working capacity returns to the patient only after a few months.
If we are talking about more modern procedures, then with laparoscopy, stitches are also sutured, but they do not need to be removed. The patient can be discharged from the hospital already 2-5 days after the operation. After that, he will need about 10-20 days to recover. Thus, determining how long the patient will be able to return to normal life, one must take into account the type of procedure.
After operation
As soon as the patient comes to himself from anesthesia, he must be examined by a doctor. He must make sure that the patient is in a satisfactory condition. The first day the patient should be in bed and eat nothing. It is forbidden to turn and leave the chamber. Toward evening, you are allowed to drink a little liquid. The patient is allowed to roll over.
The next day, he can sit on the bed or try to walk around the room. He is also given a small amount of semi-liquid nutrition. In this mode, the patient spends about a week. After this, the patient should adhere to a special diet.
If pyloroplasty was performed additionally with vagotomy, then in this case the nutrition restrictions will be more stringent. The patient needs to adhere to a diet of the order of 2-3 weeks.
If we talk about the usual procedures, then the first weeks you need to be extremely careful when performing hygiene measures. If the patient goes to the shower, then after that it is necessary to treat the body with a 5% solution of potassium permanganate. This is necessary in order to prevent the development of infection.
Finally
Of course, any surgical intervention is dangerous to humans. During the procedure, the specialist may make a mistake or not take into account the presence of additional pathologies in the patient.
Also, some do not tolerate general anesthesia. Therefore, before making a decision on surgery, the doctor must definitely check the patient's cardiovascular system. However, the refusal of the operation is also dangerous for its consequences. If we allow the further development of the disease, then the patient may require urgent hospitalization and more serious surgical intervention.