Health

Surgical options for reconstruction after antrectomy Billroth I reconstruction consists of a gastroduodenostomy in which the anastomosis is created between the gastric remnant and the duodenum Billroth II reconstruction consists of a gastrojejunostomy in which a side-to-side anastomosis is created between the gastric remnant and a loop of jejunum, with closure of the duodenal stump …

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What are the relative indications and contraindications to highly selective vagotomy?  Highly selective vagotomy is indicated for the treatment of intractable duodenal ulcers because, unlike truncal vagotomy, it does not require a drainage procedure, because antral peristalsis and sphincter function are preserved. It has also been used in the emergent treatment of bleeding or perforated …

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Why is an outlet or drainage procedure added to truncal vagotomy? What are the surgical options?  Truncal vagotomy involves division of both anterior and posterior vagal trunks at the esophageal hiatus. This procedure results in denervation of the acid-producing mucosa of the gastric fundus as well as the pylorus and antrum, causing an alteration of …

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Highly selective vagotomy Highly selective vagotomy (parietal cell vagotomy or proximal gastric vagotomy) involves selective division of the vagal fibers to the acid-producing parietal cell mass of the gastric fundus, while maintaining vagal fibers to the antrum and distal gut. The anterior and posterior neurovascular attachments are divided along the lesser curvature of the stomach, beginning …

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Selective vagotomy Selective vagotomy involves division of the vagal trunks distal to the hepatic and celiac branches, thereby preserving vagal innervation to the gallbladder and celiac plexus. This reduces the incidence of gallbladder dysmotility, gallstones, and diarrhea. However, selective vagotomy also results in complete gastric vagotomy, necessitating a drainage procedure. Selective vagotomy is not the operation …

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Truncal vagotomy Truncal vagotomy involves the division of both anterior and posterior vagal trunks at the esophageal hiatus above the origins of the hepatic and celiac branches. Periesophageal dissection must include the distal 6 to 8 cm of the esophagus to ensure division of gastric vagal branches that arise from the trunks above the level of …

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Classic operations used for PUD Truncal vagotomy and drainage Truncal vagotomy and antrectomy Highly selective vagotomy (parietal cell vagotomy or proximal gastric vagotomy)