Proksimal Gastrik Vagotomi

Yayın Yılı: 2023
Sayfa Sayısı: 71-80
DOI:
Kitap Dili : Türkçe

Anahtar Kelimeler


Despite their geographical differences, there is a gradual decrease in the prevalence of peptic ulcer disease and its complications. This may be because of the increase in H.pylori tests and the use of more potent drugs. Current indications for intervention in peptic ulcer complications are bleeding unresponsive to endoscopic treatment, perforation, ulcer-related obstruction, and intensive medical treatment. It can be considered a non-response to treatment and an inability to exclude cancer by endoscopic diagnostic methods. After understanding the physiological importance of the vagus nerve, discontinuation of cholinergic stimulation has made rational vagotomy used in treating peptic ulcer disease and its complications. Vagotomy types are truncal, selective, proximal selective, and supradiaphragmatic. Proximal gastric vagotomy, which will emphasized here, has become the most commonly used vagotomy method because it causes a decrease in basal acid secretion and maximum acid output of the stomach with an effect similar to truncal vagotomy and eliminates stasis and atony while preserving the distal motor functions of the stomach. The operation has four steps: 1. Mobilization of the stomach and exposure of the region. 2. Dissection of the anterior leaf of the lesser omentum 3. Dissection of the posterior leaf of the lesser omentum 4. Dissection of all vagal branches extending from the distal esophagus to the stomach. In this surgery, the nerve called "crow's foot" is the branch of the anterior vagus that provides the distal motor functions of the stomach and the distal branches of the Latarjet nerve. It aims to protect the vagal network and denervate all vagal branches entering the stomach except the truncal branches. This procedure is considered a safe, effective, and satisfactory method, as complications such as delayed gastric emptying, postvagotomy diarrhea, and dumping syndrome, which are vagotomy complications, are much less common. It has taken the first place in the surgical treatment of ulcer disease and its complications.

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