From the Research
Truncal vagotomy is a surgical procedure that involves cutting the main trunks of the vagus nerve where they enter the abdomen through the esophageal hiatus, and it is typically reserved for complicated cases of peptic ulcer disease or when medical therapy fails, as supported by the most recent study 1.
Definition and Purpose
Truncal vagotomy is a surgical procedure that was historically performed to reduce gastric acid secretion in patients with peptic ulcer disease, particularly those with duodenal ulcers resistant to medical therapy. During the procedure, both the anterior and posterior vagal trunks are severed, which effectively eliminates the vagal stimulation of acid-secreting parietal cells in the stomach.
Complications and Side Effects
However, truncal vagotomy also eliminates other vagal functions, including control of gastric emptying and pyloric sphincter relaxation, which can lead to complications like delayed gastric emptying (gastroparesis) and dumping syndrome.
- Gastroparesis: a condition where the stomach takes too long to empty its contents, leading to nausea, vomiting, and abdominal bloating
- Dumping syndrome: a condition where food moves too quickly from the stomach to the small intestine, leading to symptoms like diarrhea, abdominal cramps, and weakness
Current Practice and Recommendations
With the development of effective acid-suppressing medications like proton pump inhibitors and the recognition of H. pylori as a major cause of peptic ulcer disease, truncal vagotomy has become much less common in modern medical practice, reserved primarily for complicated cases or when medical therapy fails, as stated in 2. The most recent study 1 suggests that truncal vagotomy without a drainage procedure may not lead to significant complications, such as gastric stasis or intractable diarrhea, and may be a viable option in certain cases. Key points to consider:
- Truncal vagotomy is typically combined with a drainage procedure such as pyloroplasty or gastrojejunostomy to prevent gastric outlet obstruction
- The procedure should only be performed by an experienced surgeon
- Patients should be carefully selected and informed of the potential risks and benefits of the procedure, as noted in 3 and 1