Do you also have a problem with gastritis that does not heal for a long time, that is, stomach ulcers (Peptic Ulcer Disease)? Even after taking medicine, sometimes these ulcers continue to persist without healing. In such severe cases, today we are going to talk about a special surgery that doctors recommend. This is called Vagotomy. You may not have heard of this name. But this is a very important treatment method. Let's see what it is simply.
Simply put, what is Vagotomy?
Imagine that there is a special 'telephone wire' that carries information between your brain and the digestive system in your stomach. In medicine, we call this the Vagus Nerve. This nerve is what gives your stomach the signal to "secrete acid now." When we eat, it is this Vagus nerve that sends the message from the brain to produce the acid needed to digest that food.
Now, some people's stomachs produce too much acid. This can damage the lining of the stomach and cause ulcers that don't heal . A vagotomy involves cutting the part of the vagus nerve that sends messages from the brain to the stomach to produce acid. Just as cutting a telephone wire stops the message, cutting this nerve reduces the signal to the stomach to produce acid. This helps control stomach acid production, helping to heal ulcers and stop new ones from forming.
This is not something that is done for a normal gastritis condition. It is a last resort for severe, complicated stomach ulcers that cannot be cured with medication.
What are the main types of vagotomy surgery?
The vagus nerve is like a tree trunk that starts out as a branch. Vagotomy surgery can be divided into two main types depending on where the nerve is cut. The effects of each are slightly different.
| Type of surgery | Simple explanation |
|---|---|
| Truncal Vagotomy | This involves cutting off the main trunk of the vagus nerve. This is like cutting off the main trunk of a tree. This affects not only the stomach, but also the signals to the liver, gallbladder, pancreas, and intestines. Although this significantly reduces acid, it can also affect other parts of the digestive system (side effects). |
| Highly Selective Vagotomy | In this, nothing is done to the main nerve trunk. Instead, only very small nerve branches that carry signals to the acid-producing cells (parietal cells) in the stomach are selectively cut and removed. This is like cutting off just one branch of a tree without damaging the trunk. This results in very few side effects. However, this is a somewhat difficult operation for the surgeon to perform and requires more skill. |
Then in what cases is this surgery performed?
Usually, stomach ulcers can be treated with medication. However, there are some severe cases. That's when you have to consider a vagotomy surgery.
- Bleeding Ulcers: If a stomach ulcer continues to bleed and cannot be controlled with methods such as endoscopy, surgery may be needed to repair the ulcer. A vagotomy may also be performed to prevent further ulcer formation.
- Perforated Ulcers: This is an emergency. If the ulcer is deep enough to cause a hole in the wall, stomach acid and food can leak into the abdominal cavity, causing a serious infection . In such cases, surgery is needed to close the hole as soon as possible. A vagotomy may also be performed. In such cases, you will be admitted to the Emergency Department (ETU) immediately.
- Gastric Outlet Obstruction: Scar tissue from long-term injuries can block the passage of food from the stomach to the small intestine. This can cause food to get stuck in the stomach and cause vomiting . A vagotomy may also be performed during surgery to remove this obstruction.
Other surgeries performed along with vagotomy
Vagotomy is often not a stand-alone surgery. It is performed in conjunction with other surgeries to correct complications caused by injuries.
1. Vagotomy with Gastrectomy
In some severe cases, a section of the stomach may need to be removed. This is called a gastrectomy. Most often, the lower part of the stomach is removed. This part produces a hormone called gastrin. This hormone also helps produce acid. So when a section of the stomach is removed, a vagotomy is also done to prevent re-injury.
2. Vagotomy with Pyloroplasty
If we do the Truncal Vagotomy surgery that we talked about earlier, we definitely need to do this pyloroplasty surgery at the same time. At the end of the stomach, there is a muscular valve-like part called the pylorus. This is like a gate that opens and closes to let food pass into the small intestine. When the main trunk of the vagus nerve is cut in a truncal vagotomy, the signals that open and close this gate are lost. Then the food gets stuck in the stomach. Pyloroplasty surgery is done to adjust that gate so that it is always open. Then the food passes easily into the small intestine.
What happens before and during surgery?
Before the surgery, you will be given the necessary treatment to keep your health in good condition. For example, you will be given saline if you are dehydrated due to vomiting, or blood if you have lost blood due to bleeding. You will also be given antibiotics to prevent infection and medications to prevent blood clots . The surgery is performed under anesthesia , which means you will be completely asleep.
There are two ways to perform the surgery:
- Open Surgery: The traditional method, performed through a large incision in the abdomen.
- Laparoscopic Surgery: This is also known as 'keyhole surgery'. It is a procedure that involves making just a few small incisions in the abdomen and inserting a camera and delicate instruments. This results in less healing time and smaller scars.
The surgeon will decide which method is best for you.
What happens after surgery? Possible risks and side effects
Depending on the nature of the surgery, you may need to stay in the hospital for a few days. You will be sent home when you are able to walk and function independently again. It may take several weeks to fully recover. You will start with a liquid diet and gradually adjust to regular food.
Like any surgery, this one has some risks.
| Risks and side effects | Description |
|---|---|
| Risks during surgery | Damage to surrounding organs, blood vessels, or nerves, infection, excessive bleeding, blood clots, etc. |
| Diarrhea | This is a common side effect, especially after truncal vagotomy. This condition occurs when bile suddenly leaks into the intestine due to a decrease in nerve signals to the gallbladder. This is usually temporary. |
| Dumping Syndrome | This is caused by pyloroplasty surgery. As food moves quickly from the stomach to the intestines, nausea, stomach discomfort, and diarrhea may occur immediately after eating. Sometimes, a few hours later, blood sugar levels may suddenly drop and you may feel faint. This can be controlled by changing your diet. |
| Gallstones | After truncal vagotomy, bile may accumulate and form stones due to decreased gallbladder function. |
These side effects do not occur in everyone. And your doctor will give you medication and advice to manage most of them. Most importantly, the main benefit of this surgery is the ability to completely heal long-standing, unhealed stomach ulcers.
Take-Home Message
- Vagotomy is a special surgery performed for severe and complicated stomach ulcers (Peptic Ulcers) that cannot be cured with medication.
- Here, the relevant part of the Vagus Nerve, which carries signals from the brain to the stomach to produce acid, is cut and removed.
- There are two main types of this surgery: Truncal Vagotomy and Highly Selective Vagotomy.
- This is often done in conjunction with another surgery, such as a gastrectomy or pyloroplasty.
- Side effects such as diarrhea and dumping syndrome may occur after surgery, but most of them can be managed.
- Whether this surgery is right for you should be decided after a thorough examination of your medical condition and in consultation with your specialist surgeon.
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