Highly selective gastric vagotomy

Mainly used in cases of duodenal ulcer with surgical indications, such as bleeding (including some stress ulcer bleeding), perforation, scar pyloric obstruction, refractory ulcer and simple gastrointestinal anastomosis or partial gastric resection Postoperative anastomotic ulcers, etc. Vagotomy is divided into two types: vagus nerve dry surgery and selective vagus nerve cutting. The former is simple in operation, but often has symptoms such as abdominal distension and diarrhea after surgery. It is suitable for patients with higher risk; the latter is less sensitive to postoperative gastrointestinal function, but the operation is more complicated and suitable for surgical tolerance. Better patient. Because both must be accompanied by gastric drainage or partial gastric resection, the surgery can be completed; in recent years, highly selective gastric vagotomy (also known as parietal vagus nerve ablation) has been developed. Only the vagus nerve in the cell wall region of the stomach can be cut off without additional gastric drainage or semi-gastric or sinus resection, which can be performed as an independent operation. This procedure has great advantages in theory, but the surgical operation is strict. See the schematic diagram for the three types of surgery. Treatment of diseases: gastroduodenal ulcer scar pyloric obstruction stomach, duodenal ulcer bleeding stomach, duodenal ulcer acute perforation Indication Mainly used in cases of duodenal ulcer with surgical indications, such as bleeding (including some stress ulcer bleeding), perforation, scar pyloric obstruction, refractory ulcer and simple gastrointestinal anastomosis or partial gastric resection Postoperative anastomotic ulcers, etc. Vagotomy is divided into two types: vagus nerve dry surgery and selective vagus nerve cutting. The former is simple in operation, but often has symptoms such as abdominal distension and diarrhea after surgery. It is suitable for patients with higher risk; the latter is less sensitive to postoperative gastrointestinal function, but the operation is more complicated and suitable for surgical tolerance. Better patient. Because both must be accompanied by gastric drainage or partial gastric resection, the surgery can be completed; in recent years, highly selective gastric vagotomy (also known as parietal vagus nerve ablation) has been developed. Only the vagus nerve in the cell wall region of the stomach can be cut off without additional gastric drainage or semi-gastric or sinus resection, which can be performed as an independent operation. This procedure has great advantages in theory, but the surgical operation is strict. See the schematic diagram for the three types of surgery. Preoperative preparation 1. Patients with pyloric obstruction, due to the retention of gastric contents, bacteria are easy to multiply, resulting in mucosal congestion and edema, which hinders the healing of postoperative anastomotic stoma. Fasting before surgery, gastric lavage before surgery, so that the stomach is drained as much as possible to reduce inflammation. 2. Appropriate fluid replacement, blood transfusion, and correction of water and electrolyte imbalance. 3. Before entering the operating room, the stomach tube should be taken out to evacuate the stomach contents to avoid vomiting during anesthesia, causing asphyxia and pulmonary complications. Surgical procedure 1. Position: supine, the upper torso is high, and the xiphoid is kept at the highest position, which is conducive to the exposure of the cardia. 2. Incision: same as vagus nerve trunk surgery. 3. Reveal the small curvature of the stomach: reveal the cardia, the lower end of the esophagus and the small curvature of the stomach. If necessary, it can be pulled on the large curved side. The vagus nerve anterior branch (Latarjet nerve) and the crow's paw can be clearly identified. 4. Separation of the small omentum: 5 to 7 cm from the pyloric vein, slightly above the first branch of the crow claw, in the direction indicated by the black line arrow, close to the anterior lobe of the small omentum close to the stomach wall. 5. Exposing the vagus nerve: In obese people, a fissure can be cut in the avascular region of the small omentum, and the left index finger and/or middle finger are used to extend into the omentum and the back of the stomach through the fissure, and the stomach wall of the anterior branch of the stomach is more easily recognized. Branching and facilitating the separation of its separation. 6. Separate and cut off the vagus nerve branch: continue to dissect upwards and go straight to the cardia and the lower end of the esophagus. The index refers to the right side of the esophagus to the right side of the door, poke open loose tissue, around a rubber catheter, pull the cardia and esophagus to the lower right, which is beneficial to the lower end of the esophagus and the bottom of the stomach. The lower end of the esophagus and the bottom of the stomach need to be separated by about 5cm. In the process of separating and cutting off the nerve branches leading to the lower end of the esophagus and the fundus, it is especially important to note that a thicker nerve branch from the posterior trunk to the bottom of the stomach is often forgotten, commonly referred to as "nerves criminalis". If you miss this branch, you may have a recurrence of ulcers. 7. Peritoneal small curved wound: Retract the esophagus and cardia to the left side, reveal the posterior lobe of the small omentum, continue to separate and cut, until the right edge. At this point, the vagus nerve fibers leading to the cell wall region of the proximal wall of the stomach have been completely cut. The exposed wound on the small curved side of the stomach was peritoneally formed.