Abstract
Open highly selective vagotomy (HSV) has withstood the rigors of objective evaluation to become the optimal surgical treatment for chronic duodenal ulcer refractory to medical therapy in many centers. Laparoscopic HSV has not been subjected to the same scrutiny before entering clinical practice. A controlled animal study was conducted to demonstrate the physiological validity of laparoscopic HSV. Experimental groups underwent laparoscopic and open highly selective vagotomies, and control groups underwent a sham laparoscopic gastric mobilization or no operative procedure. Gastric acid output was measured by an aspiration technique, liquid gastric emptying was calculated by the double sampling technique of George, and gastroesophageal reflux was assessed by 8-h ambulatory pH monitoring. Laparoscopic HSV was as effective as its open counterpart in reducing basal acid output, and laparoscopic HSV did not interfere with liquid gastric emptying in contrast to open HSV. Neither open nor laparoscopic HSV was observed to precipitate gastroesophageal reflux. These data suggest that the continued use of laparoscopic HSV in clinical practice is appropriate.
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References
Baron JH (1978) In: Clinical tests of acid secretion. The Macmillan Press, London, pp 153–178
Beckers EJ, Rehrer NJ, Brouns F, Ten Hoor F, Saris WHM (1988) Determination of total gastric volume, gastric secretion and residual meal using the double sample technique of George. Gut 29: 1725–1729
Cadiere GB, Himpens J, Bruyns J (1994) Laparoscopic proximal gastric vagotomy. End Surg 2: 105–108
Cohen F, Valleur P, Serra J, Brissett D, Chiche L, Hautefeuille P (1993) Relationship between gastric acid secretion and the rate of recurrent ulcer after parietal cell vagotomy. Ann Surg 217: 253–259
Cuschieri A (1992) Laparoscopic vagotomy. Gimmick or reality? Surg Clin North Am 72: 357–367
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1994) Laparoscopic highly selective vagotomy. Br J Surg 81: 554–556
Donahue PE, Yoshida J, Richter Bombeck CT, Nyhus LM, Maroske D, Thon KP, Roeher HD (1987) Can the use of an endoscopic Congo red test decrease the incidence of incomplete proximal gastric vagotomy? Gastrointest Endosc 33: 427–431
Dubois F (1994) Vagotomies—laparoscopic or thoracoscopic approach. End Surg 2: 100–104
George JD (1968) New clinical method for measuring the rate of gastric emptying: the double sample test meal. Gut 9: 237–242
Goligher JC (1974) A technique for highly selective (parietal cell or proximal gastric) vagotomy for duodenal ulcer. Br J Surg 61: 337–345
Hallenbeck GA, Gleysteen JJ, Aldrete JS, Slaughter RL (1976) Effect of two operative techniques on clinical and gastric secretory results. Ann Surg 184: 435–441
Hannon JK, Snow L, Weinstein LS (1993) Linear gastrectomy: an endoscopic staple-assisted anterior highly selective vagotomy combined with posterior truncal vagotomy for treatment of peptic ulcer disease. Surg Laparosc Endosc 2: 254–257
Hassan MA, Hobsley M (1970) Positioning of subject and nasogastric tube during a gastric secretion study. Br Med J i: 458–460
Heij HA, Seldenrijk CA, Vos A (1991) Anterior gastropexy prevents gastrostomy-induced gastroesophageal reflux: an experimental study in piglets. J Pediatr Surg 26: 557–559
Johnston D, Wilkinson AR (1969) Selective vagotomy with innervated antrum without drainage procedure for duodenal ulcer. Br J Surg 56: 626
Katkhouda N, Heimbucher J, Mouiel J (1994) Laparoscopic posterior vagotomy and anterior seromyotomy. End Surg 2: 95–99
Kum CK, Goh P (1992) Laparoscopic posterior truncal vagotomy and anterior highly selective vagotomy—a case report. Singapore Med J 33: 302–303
Lavigne ME, Wiley ZD, Martin P, Way L, Meyer JH, Sleisenger MH, MacGregor IL (1979) Gastric, pancreatic and biliary secretion and the rate of gastric emptying after parietal cell vagotomy. Am J Surg 138: 644–651
Martinoli S (1982) Lower oesophageal sphincter function. In: Baron JH, Alexander-Williams J, Allgower M, Muller C, Spencer J (eds) Vagotomy in modern surgical practice. Butterworths, London, pp 62–65
Neugebauer E, Troidl H, Spangenberger W, Dietrich A, Lefering R, The Cholecystectomy Study Group (1991) Conventional versus laparoscopic cholecystectomy and the randomized controlled trial. Br J Surg 78: 150–154
Nylamo EI (1987) Relationship between gastric acid secretion and clinical outcome after parietal cell vagotomy. Acta Chir Scand 153: 33–36
Schedl PH (1966) Use of polyethylene glycol and phenol red as unabsorbed indicators for intestinal absorption studies in man. Gut 7: 159
Schneider TA, Wittgen CM, Andrus CH, Kaminski DL (1992) Comparison of minimally invasive methods of parietal cell vagotomy in a porcine model. Surgery 112: 649–654
Temple JG, McFarland J (1975) Gastro-oesophageal reflux complicating highly selective vagotomy. Br Med J 2: 168–169
Wilbur BG, Kelly KA (1973) Effect of proximal gastric, and truncal vagotomy on canine gastric electric activity, motility and emptying. Ann Surg 178: 295–303
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Bessell, J.R., Pike, G., Jamieson, G.G. et al. Physiological outcome following laparoscopic highly selective vagotomy. Surg Endosc 9, 1283–1288 (1995). https://doi.org/10.1007/BF00190160
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DOI: https://doi.org/10.1007/BF00190160