Skip to main content
NCBI home page
British Medical Journal logoLink to British Medical Journal
. 1972 Sep 30;3(5830):788–790. doi: 10.1136/bmj.3.5830.788

Vagotomy without Diarrhoea

D Johnston, C S Humphrey, B E Walker, C N Pulvertaft, J C Goligher
PMCID: PMC1786320  PMID: 5076248

Abstract

The incidence of diarrhoea after three types of vagotomy was assessed “blind” at a gastric follow-up clinic one year after operation. Diarrhoea was recorded in 24% of patients after truncal vagotomy and pyloroplasty, in 18% after selective vagotomy and pyloroplasty, but in only 2% of patients after highly selective vagotomy without a drainage procedure. The incidence of diarrhoea was significantly less (P < 0·01) after highly selective vagotomy than after either of the other procedures.

Hypertonic glucose solution given by mouth to 15 representative patients from each group and to 15 patients before operation provoked the onset of diarrhoea in 67% of the patients who had undergone truncal vagotomy and pyloroplasty, in 60% of those who had undergone selective vagotomy and pyloroplasty, in 13% of those who had undergone highly selective vagotomy without a drainage procedure, and in none of the preoperative patients. Again the difference between the “highly selective” group and the other two groups of vagotomized patients was statistically significant.

It is suggested that postvagotomy diarrhoea is attributable both to unregulated gastric emptying after truncal or selective vagotomy with a drainage procedure and to the extragastric denervation produced by truncal vagotomy. “Postvagotomy” diarrhoea can be virtually eliminated by using highly selective vagotomy without a drainage procedure.

Full text

PDF
788

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amdrup E., Jensen H. E. Selective vagotomy of the parietal cell mass preserving innervation of the undrained antrum. A preliminary report of results in patients with duodenal ulcer. Gastroenterology. 1970 Oct;59(4):522–527. [PubMed] [Google Scholar]
  2. BURGE H. W., RIZK A. R., TOMPKIN A. M., BARTH C. E., HUTCHISON J. S., LONGLAND C. J., McLENNAN I., MILN D. C. Selective vagotomy in the prevention of post-vagotomy diarrhoea. Lancet. 1961 Oct 21;2(7208):897–899. doi: 10.1016/s0140-6736(61)90405-6. [DOI] [PubMed] [Google Scholar]
  3. Clarke R. J., McFarland J. B., Williams J. A. Gastric stasis and gastric ulcer after selective vagotomy without a drainage procedure. Br Med J. 1972 Feb 26;1(5799):538–539. doi: 10.1136/bmj.1.5799.538. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dragstedt L. R., Harper P. V., Tovee E. B., Woodward E. R. Section of the Vagus Nerves to the Stomach in the Treatment of Peptic Ulcer : Complications and End Results After Four Years. Ann Surg. 1947 Nov;126(5):687–699. [PMC free article] [PubMed] [Google Scholar]
  5. Foster R. P. Delayed haemorrhage from the ruptured spleen. Br J Surg. 1970 Mar;57(3):189–192. doi: 10.1002/bjs.1800570309. [DOI] [PubMed] [Google Scholar]
  6. Goligher J. C., Pulvertaft C. N., De Dombal F. T., Conyers J. H., Duthie H. L., Feather D. B., Latchmore A. J., Shoesmith J. H., Smiddy F. G., Willson-Pepper J. Five to eight-year results of Leeds-York controlled trial of elective surgery for duodenal ulcer. Br Med J. 1968 Jun 29;2(5608):781–787. doi: 10.1136/bmj.2.5608.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goligher J. C., Pulvertaft C. N., Irvin T. T., Johnston D., Walder B., Hall R. A., Willson-Pepper J., Matheson T. S. Five- to eight-year results of truncal vagotomy and pyloroplasty for duodenal ulcer. Br Med J. 1972 Jan 1;1(5791):7–13. doi: 10.1136/bmj.1.5791.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. HARKINS H. N., STAVNEY L. S., GRIFFITH C. A., SAVAGE L. E., KATO T., NYHUS L. M. SELECTIVE GASTRIC VAGOTOMY. Ann Surg. 1963 Sep;158:448–460. doi: 10.1097/00000658-196309000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hedenstedt S., Lundquist G. Selective gastric vagotomy versus total abdominal vagotomy. Acta Chir Scand. 1966 Jun;131(6):448–459. [PubMed] [Google Scholar]
  10. Hendry W. G., Abdulla K. H. Diarrhoea after vagotomy. A comparative study of truncal and bilateral selective vagotomy. Br J Surg. 1969 Jan;56(1):1–3. doi: 10.1002/bjs.1800560102. [DOI] [PubMed] [Google Scholar]
  11. Kennedy T., Connell A. M. Selective or truncal vagotomy? Lancet. 1970 Mar 28;1(7648):675–675. doi: 10.1016/s0140-6736(70)90908-6. [DOI] [PubMed] [Google Scholar]
  12. Kraft R. O., Fry W. J., Wilhelm K. G., Ransom H. K. Selective gastric vagotomy. A critical reappraisal. Arch Surg. 1967 Oct;95(4):625–630. doi: 10.1001/archsurg.1967.01330160095012. [DOI] [PubMed] [Google Scholar]
  13. Kronborg O., Malmström J., Christiansen P. M. A comparison between the results of truncal and selective vagotomy in patients with duodenal ulcer. Scand J Gastroenterol. 1970;5(6):519–524. [PubMed] [Google Scholar]
  14. Mason M. C., Giles G. R., Graham N. G., Clark C. G., Goligher J. C. An early assessment of selective and total vagotomy. Br J Surg. 1968 Sep;55(9):677–680. doi: 10.1002/bjs.1800550908. [DOI] [PubMed] [Google Scholar]
  15. McKelvey S. T., Connell A. M., Kennedy T. L. Gastric emptying and transit time as factors in postvagotomy diarrhea. Gut. 1969 Dec;10(12):1047–1047. [PubMed] [Google Scholar]
  16. McKelvey S. T. Gastric incontinence and post-vagotomy diarrhoea. Br J Surg. 1970 Oct;57(10):741–747. doi: 10.1002/bjs.1800571012. [DOI] [PubMed] [Google Scholar]
  17. Sawyers J. L., Scott H. W., Jr, Edwards W. H., Shull H. J., Law D. H., 4th Comparative studies of the clinical effects of truncal and selective gastric vagotomy. Am J Surg. 1968 Feb;115(2):165–172. doi: 10.1016/0002-9610(68)90024-x. [DOI] [PubMed] [Google Scholar]
  18. Tovey F. I. A comparison of Polya gastrectomy, total and selective vagotomy, and of pyloroplasty and gastrojejunostomy. Br J Surg. 1969 Apr;56(4):281–286. doi: 10.1002/bjs.1800560411. [DOI] [PubMed] [Google Scholar]
  19. Williams E. J., Irvine W. T. Functional and metabolic effects of total and selective vagotomy. Lancet. 1966 May 14;1(7446):1053–1057. doi: 10.1016/s0140-6736(66)91006-3. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES