You might think that some people have stomach ulcers, that is, gastric ulcers, and no matter what medicine they take or how much they control their diet, it will never heal. There are people who face such severe conditions that cause continuous pain, bleeding, and sometimes even perforation of the stomach. For such people, when all other treatments have failed, we are talking today about a special surgery that doctors recommend. It is called a vagotomy.
Simply put, what is a vagotomy?
Think of it this way: the Vagus nerve is like a main telephone line between our brain and the digestive system, including the intestines. This nerve is what sends the signal to our stomach to "secrete acid now." Although this acid is needed when we eat, sometimes the increase in this acid is the main cause of stomach ulcers.
Vagotomy is the deliberate cutting of the part of the telephone line, the vagus nerve, that sends signals to the stomach to make acid, thereby stopping that signal. This significantly reduces the production of stomach acid. This is a somewhat radical but very effective treatment for people with the most severe forms of peptic ulcer disease.
What happens when the vagus nerve is severed? - There are two main types
The vagus nerve is like a tree. It has a main trunk, from which various branches branch off. The effect of the surgery varies depending on where this nerve is cut. There are two main types.
| Type of surgery | What happens and the impact |
|---|---|
| Truncal Vagotomy | This involves cutting the "main trunk" of the vagus nerve. This reduces the production of stomach acid, but it can also affect the function of other organs that receive signals from this nerve, such as the liver, gallbladder, pancreas, and intestines. This can cause digestive problems. |
| Highly Selective Vagotomy | This is a very specific method. Here, the entire nerve trunk is not cut. Only very small nerve branches that carry signals to the acid-producing cells (parietal cells) in the stomach are selected and cut away. This does not affect other organs. However, this is a somewhat difficult operation for the surgeon to perform and requires more technical knowledge. |
In what cases is this surgery recommended?
Most stomach ulcers can be treated with medication. However, in complex and severe cases, such as the following, this surgery may be recommended to prevent the ulcers from recurring:
- Bleeding Ulcers: If other methods cannot control the bleeding, surgery may be necessary to heal the ulcer.
- Perforated Ulcers: If the ulcer causes a hole in the stomach wall, it must be closed with emergency surgery. Otherwise, germs can enter the stomach and cause a serious infection. In such a case, you should be taken to the ETU (Emergency Treatment Unit) immediately.
- Gastric Outlet Obstructions: Scar tissue from long-term injuries can block the passage of food from the stomach to the small intestine. In this case, the scar tissue must be removed surgically.
Importantly, vagotomy is not usually performed alone. It is often performed in conjunction with another operation to correct one of the complications mentioned above.
Other operations performed at the same time as vagotomy
1. With gastrectomy: This involves removing part of the stomach. This is done if there are severe scars or if there is a suspicion that the lesions may be cancerous. When the lower part of the stomach is removed, the production of gastrin, a hormone that helps make acid, is also reduced. But since that alone is not enough, a vagotomy is also performed at the same time to prevent the lesions from recurring.
2. With Pyloroplasty: If you are having a Truncal Vagotomy, which means cutting the main nerve trunk, you will definitely have to have this pyloroplasty surgery as well. Because, when the vagus nerve is cut, the signal that tells the pylorus to open and close is lost. Then the food gets stuck. Pyloroplasty surgery is done to keep that gate open, so that the food passes easily.
What happens before and during the surgery?
Depending on your condition, some treatments may be given before surgery to help you regain your health. For example, IV fluids may be given if you are dehydrated due to vomiting, or a blood transfusion may be given if you have a bleeding wound. Antibiotics are given before surgery. This surgery is performed under general anesthesia.
The surgery can be done as open surgery , which involves cutting open the abdomen, or laparoscopic surgery , which involves inserting a camera and instruments through several small incisions. This will be decided by your surgeon.
What happens after surgery? Benefits and risks
The main advantage of this surgery is that it can almost completely stop the recurrence of severe wounds that have been suffering for a long time and have not been healed by medication.
However, like any surgery, this one has some risks and side effects .
| Risk/side effect type | Description |
|---|---|
| Risks during surgery | Damage to surrounding organs, blood vessels, or nerves, infection, bleeding, blood clots. |
| Diarrhea | This is a common condition, especially after truncal vagotomy. It is caused by a decrease in gallbladder function. It is usually temporary. |
| Dumping Syndrome | This is due to pyloroplasty surgery. Food passes quickly into the intestines without staying in the stomach, which can cause nausea, stomach discomfort, and diarrhea. This can be controlled by changing your diet. |
| Gallstones | After truncal vagotomy, decreased gallbladder function can lead to bile accumulation and the formation of stones. |
You will need to stay in the hospital for a few days after the surgery. It may take a few weeks before you can eat normally. You will start with liquid foods and gradually move on to solid foods.
Take-Home Message
- Vagotomy is a surgical procedure that is performed as a last resort for severe stomach ulcers (peptic ulcers) that are not treated with medication.
- The primary goal is to reduce acid production by cutting off the nerve signals that produce acid in the stomach.
- There are two main types of this surgery (truncated and highly selective), and their side effects and effects are different.
- This is often done in conjunction with other surgeries (gastrectomy, pyloroplasty) to treat complications of the ulcer.
- If you or someone you know has been recommended this type of surgery, be sure to talk to your doctor about the benefits, risks, and side effects and ask all your questions.
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