Elective 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. Treatment of diseases: gastroduodenal ulcer, scar pyloric obstruction, duodenal ulcer 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. 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, incision: same with vagus nerve trunk surgery. 2. Exposing the vagus nerve trunk: Pulling the left outer lobe of the liver to reveal the esophageal hiatus. The procedure of cutting the local peritoneum, separating the esophagus, and exposing the nerve trunk is the same as that of the vagus nerve stem. 3. Cut the anterior branch of the stomach: first use a piece of rubber to bypass the vagus nerve and gently pull it open, then expand the small omentum incision downward. The assistant pulls the stomach down and can see the liver branch buried in the small omentum. Similarly, gently lift the rubber strip around the liver branch and reverse it upwards to clearly see the part of the liver branch. After gently pulling the liver branch away, cut the anterior branch of the stomach at the point of separation and try to separate the branches from the small curvature of the stomach. 4. Cut the posterior branch of the stomach: The esophagus and the cardia are pulled to the left side. In the loose tissue of the retroperitoneum on the right side of the esophagus above the cardia, the string-like strips can be seen or touched, that is, the vagus nerve is dried, and separated, and then used. The rubber sheet is bypassed and gently pulled. Then, the sputum assistant pulls the stomach down and pulls the anterior and hepatic branches gently to the right. Looking down the back, you can see or touch the abdominal branch of the celiac artery plexus, gently pull it open, cut off the posterior branch of the stomach at the point of separation, and try to separate its branches to the small curvature of the stomach. . 5. Cut off the vagus nerve on the iliac crest: Some stomach branches may be directly emitted from the upper vagus nerve trunk before and after the anterior and posterior iliac crests are distributed, and distributed to the anterior and posterior walls of the stomach near the cardia. Therefore, the vagus nerve must be opened before and after the vagus nerve, and the supraorbital nerve trunk should be carefully examined retrogradely near the cardia, and the nerve fibers distributed to the lower esophagus should be retained, and the fibers distributed to the anterior and posterior walls of the stomach near the cardia should be cut off one by one. support. If there is a part of the stomach fiber, there will be a possibility of recurrence of the ulcer. 6. Suture the peritoneum of the esophageal hiatus: suture the peritoneal incision at the esophageal hiatus and reset the left lobe of the liver, and then perform gastric drainage or partial gastrectomy. According to the principle of sterility, vagus nerve ablation should be performed first, followed by gastric drainage or partial gastrectomy. Only in cases of ulcerative bleeding, the stomach and duodenum are treated first, and the vagus nerve is treated after bleeding control.