Vagotomy

A vagotomy is a surgical procedure that is performed only in humans. It is resection (removal of, or at least severing) of part of the vagus nerve.

The operation was popular up until the mid-1990s as a way of treating peptic ulcer disease, and preventing its recurrence. It was (incorrectly) thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the peptic cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of gastro-esophageal reflux in those who suffered from it.

The incidence of vagotomy decreased following the discovery by Barry Marshall and Robin Warren that Helicobacter pylori is responsible for most peptic ulcers. The first-line treatment for peptic ulcer disease, if due to H. pylori, is "triple therapy": 2 antibiotics (clarithromycin and amoxicillin or metronidazole)and a proton pump inhibitor (e.g. omeprazole). However, in chronic ulceration or in gastric outlet obstruction there is still an important role for truncal vagotomy.

A plain vagotomy is a very destructive procedure, since all the parasympathetic supply from the stomach to the left side of the transverse colon relies on the vagus nerves. The gut will still function without vagus supply, but less well.

Vagotomy technique was therefore improved by restricting resection to only those branches that go to the stomach (selective vagotomy), and further by selecting only those branches that appear to supply peptic cells (highly selective vagotomy).

Humans have two vagus nerves, whose fibres decussate and intermingle around the stomach. Accordingly, a vagotomy operates on both nerves simultaneously and in practise there is no need or way to make a distinction between them.