A relic or still relevant: The narrowing role for vagotomy in the treatment of peptic ulcer disease

Janaka Lagoo, Theodore N. Pappas, Alexander Perez

Research output: Contribution to journalReview article

32 Scopus citations

Abstract

Background Given the rise of medical treatment for peptic ulcer disease (PUD), surgical treatment is necessary only in select cases and emergencies. The authors assess the current relevance of surgical vagotomy to treat PUD and its complications. Data Sources Although historically significant, selective and highly selective vagotomy is very technically challenging, and highly selective vagotomy has a relatively narrow indication and high recurrence rates. Vagotomy and gastrectomy is associated with significant side effects. Two types of vagotomy remain relevant, within a narrow scope. Truncal vagotomy and pyloroplasty is safe and efficacious through a laparoscopic approach in certain emergent cases. Vagotomy and Roux-en-Y gastrojejunostomy can be used to treat severe PUD refractory to medical management. Conclusions The role of vagotomy in the management of PUD has a rich history but predated pharmacologic control of acid and understanding of the role of Helicobacter pylori in the disease. Thus, the current role of vagotomy is significantly limited. Specifically, the emergent use of truncal vagotomy is warranted for patients who are either resistant or allergic to proton pump inhibitors.

Original languageEnglish (US)
Pages (from-to)120-126
Number of pages7
JournalAmerican Journal of Surgery
Volume207
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Keywords

  • Highly selective vagotomy
  • Peptic ulcer disease
  • Proton pump inhibitors
  • Selective vagotomy
  • Truncal vagotomy
  • Vagotomy

ASJC Scopus subject areas

  • Surgery

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