Truncal Vagotomy Without Drainage: Are There Long Term Concerns?

Matt B Martin, MD. Central Carolina Surgery, PA, Cone Health, Greensboro, NC.

 Introduction: Panelists at SAGES 2012 implied that inadvertent vagotomy was the cause of the bloating, diarrhea, and delayed gastric emptying that is often seen after complex foregut reconstructions that require extensive esophageal dissection. Is it correct to ascribe these symptoms to vagotomy and imply that a drainage procedure should accompany truncal vagotomy? To examine the long term sequellae of truncal vagotomy alone the present report examines clinical outcomes of 49 patients who had truncal vagotomy without drainage.

Methods: 49 patients underwent truncal vagotomy with laparoscopic gastric banding in a trial to determine if the addition of a vagotomy would increase the achieved weight loss when compared to gastric banding alone. The details of this trial were presented at SAGES in 2010. The patients in this study are all now out greater than 5 years

Results: 49 patients have been followed a mean of 4.9 years. All except one have experienced a loss of hunger and cessation of gastric borborygmi. One patient showed mild delayed gastric emptying when evaluated for GERD. No patient has experienced intractable diarrhea.

Conclusions: These outcomes do not support the prevailing surgical thinking that vagotomy should always be accompanied by a drainage procedure. Furthermore, these outcomes would suggest that it is misleading to ascribe inadvertent vagotomy as the cause of the bloating, diarrhea, and delayed gastric emptying that occasionally is seen after difficult esophageal dissections.

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