what is the difference between selective and highly selective vagotomy, is selective vagotomy performed in practice?And when to perform truncal vagotomy?
Selective vagotomy, highly selective vagotomy, and truncal vagotomy are surgical procedures that were historically used to treat peptic ulcers and certain acid-related gastrointestinal conditions. However, due to advancements in medical treatments like proton pump inhibitors (PPIs), these surgical procedures are less commonly performed today. Let’s explore the differences between these procedures:
- Selective Vagotomy:
- Selective vagotomy involves cutting the branches of the vagus nerve that innervate only the acid-producing cells (parietal cells) of the stomach. This helps reduce stomach acid secretion while preserving other functions of the stomach and digestive tract.
- This procedure aims to achieve a balance between reducing acid production and maintaining normal gastric function.
- Selective vagotomy was an attempt to address the problem of peptic ulcers without causing more extensive disruptions to gastric function.
- Highly Selective Vagotomy:
- Highly selective vagotomy is a refinement of selective vagotomy. It involves even more precise cutting of only the nerves that supply the acid-producing cells, leaving other functions of the stomach largely intact.
- The goal of highly selective vagotomy is to minimize side effects associated with broader nerve resections while still achieving the desired reduction in acid production.
- Truncal Vagotomy:
- Truncal vagotomy involves cutting the main trunk (trunk of the vagus nerve) that supplies the stomach.
- This procedure significantly reduces stomach acid production but also has more profound effects on gastric function compared to selective vagotomy.
- In the past, truncal vagotomy was often combined with a drainage procedure called pyloroplasty or antrectomy to manage the side effects of reduced stomach emptying.
While these procedures were once commonly performed to treat peptic ulcers, their popularity has declined with the development of more effective and less invasive medical treatments, such as proton pump inhibitors (PPIs). PPIs are medications that can effectively reduce stomach acid production and promote ulcer healing without the need for surgery.
In modern medical practice, surgical interventions for peptic ulcers are typically reserved for cases where medical treatments have failed or for specific complications that require surgical management. The choice of surgical procedure depends on various factors, including the patient’s overall health, the extent of the ulcer disease, and the expertise of the surgical team.
It’s important to note that medical science and practice evolve over time, and the information provided is based on the knowledge available up to September 2021. For the most up-to-date information and recommendations, it’s recommended to consult with a medical professional.