What Is the Purpose of a Vagotomy?

Vagotomy is a surgical procedure to sever part of the nerve that controls digestion. The aim is to reduce stomach acid.

The vagus nerve is responsible for sensory and motor functions of the internal organs such as heart, lungs and the gastrointestinal system. The vagus nerve runs from the brain, down the neck, alongside the esophagus, and over the stomach and intestines.

Vagotomy is a procedure to surgically remove a part or the whole of the portion of the vagus nerve that controls the digestive system. The vagus nerve stimulates gastrointestinal functions such as acid production for digestion and moving the food through the gastrointestinal system (peristalsis).

There are primarily three types of vagotomy:

• Truncal vagotomy: The two main trunks (anterior and posterior) of the vagus nerve are cut above the place where the esophagus joins the stomach (gastroesophageal junction). A truncal vagotomy removes the nerve going through the entire gastrointestinal system including the liver, gallbladder, pancreas and bowels. It is usually accompanied by another surgery to widen the stomach outlet (pylorus) into the intestine (pyloroplasty), because the digestive system also loses its peristalsis function.
• Selective vagotomy: The vagus nerve divides below the gastroesophageal junction and only the portion going to the stomach is cut. The trunk of the nerve going to the remainder of the gastrointestinal organs are left intact. A selective vagotomy is also usually accompanied by a pyloroplasty.
• Highly selective vagotomy: Only the portion of the vagus nerve connected to the part of stomach that produces acid is removed. The nerve function of the lower stomach and the other organs are preserved.

Stimulated by the vagus nerve, the stomach produces acid to digest food. When the stomach produces excessive acid, it can corrode the stomach lining and cause peptic ulcers. The purpose of a vagotomy is to disable the stomach’s acid producing capacity.

With the development of excellent medications for the acid reflux-inducing bacteria Helicobacter pylori infection and acid production control, the requirement for vagotomy is greatly reduced. It is mostly performed to treat the following:

• Pyloric stenosis, or narrowing of the stomach’s opening into the intestine
• Peptic ulcers that do not respond to medication, diet and lifestyle modification
• Chronic, recurring ulcers
• Emergencies with gastrointestinal inflammation and bleeding due to ulcers

A vagotomy is usually performed under general anesthesia by a gastrointestinal surgeon as an open or laparoscopic surgery.

Preparation

• Before a vagotomy, a patient
• Undergoes blood, urine and imaging tests, and possibly a gastroscopy.
• Must not eat or drink 8 hours prior to the procedure.
• Must check with the doctor before taking any regular medications.
• Must inform the doctor of any allergies.
• May need blood transfusion in case of bleeding peptic ulcers.

Procedure

• An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
• The patient will be intubated for supplemental oxygen.
• The surgeon makes one or more incisions in the abdomen depending on the type of surgery.
• Depending on the type of vagotomy, the surgeon cuts the vagus nerve above or below the gastroesophageal junction or just the parts connected to the body of the stomach.
• The surgeon may remove a part of the lower stomach (antrectomy) or perform a pyloroplasty.
• The surgeon may remove the duodenum in certain situations and connect the stomach directly to the jejunum, the middle part of the small intestine (gastrojejunostomy).
• The abdominal muscles and the incision are closed with sutures.

Post-procedure

• The patient will be monitored in the recovery room for several hours.
• The patient may require up to a week of hospitalization.
• Complete recovery may take up to six weeks during which the patient may be required to
  • follow a specific diet
  • avoid spicy and acidic foods
  • avoid heavy lifting
  • avoid strenuous activities

A vagotomy may cause side effects such as:

• Anesthetic side effects such as headache, nausea and confusion
• Postvagotomy diarrhea (mainly with truncal vagotomy)
• Delayed gastric emptying (gastroparesis) which is usually prevented with a pyloroplasty
• Change in digestive patterns and need to be on a special diet

The vagotomy surgery itself is a relatively safe procedure, but has a few potential postoperative complications including:

• Risks of surgery such as
  • Wound infection
  • Pneumonia
  • Bleeding
  • Blood clots
  • Damage to internal organs, blood vessels or nerves
• Gastric leak
• Internal hernia
• Gastric dumping syndrome due to the stomach contents emptying too quickly into the intestine
• Bile reflux and chronic gastritis caused by gastrojejunostomy
• Formation of gallstones (mainly after a truncal vagotomy)
• Bowel blockage due to problems with peristalsis
• Recurrence of ulcers (a low risk with truncal vagotomy)
• Stomach or intestinal cancer