Laparoscopic Vagotomy and Pyloroplasty

A. The Condition. You may have an ulcerous condition of the stomach or duodenum in which surgical treatment is recommended. The vagus nerve controls acid secretion in your stomach. Cutting the vagal nerves reduces acid production, which allows your ulcers to heal.

B. Symptoms

• Abdominal pain, especially at night
• Weight loss, weakness
• Vomiting blood

C. Laparoscopic Vagotomy and Pyloroplasty. The surgeon will make about 4-5 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to cut the vagal nerves, up near the diaphragm where the nerves enter the abdomen. After the vagal nerves have been cut (the vagotomy), the outlet to your stomach will be opened up (the pyloroplasty) to prevent blockage later on. After this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. Sometimes your problem may be treated with medication (antacids and/or various medicines that reduce acid production in the stomach). Your doctor will discuss with you what your best option is.

E. Risks. The primary risks of laparoscopic vagotomy and pyloroplasty are:

• Infection of the skin at one of the small ports sites
• Perforation of the stomach
• Slow emptying of food from the stomach
• Leakage of the pyloroplasty
• Postoperative ileus (the intestines slow down/stop working for several days)

F. Expectations

1. Before Your Operation. Laparoscopic vagotomy and pyloroplasty usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, a barium swallow x-ray, and endoscopy (looking down your throat with a scope). If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home 2-4 days after a laparoscopic vagotomy and pyloroplasty. You may need to wait until your bowels start working. You will be given medication for pain. Your doctor will discuss with what to do with your anti-ulcer medications. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• High fever
• Severe abdominal pain
• Odor or increased drainage from your incision
• Nausea and vomiting
• No bowel movements for three days

G. Pertinent References

Frantzides CT, Ludwig KA, Quebbeman EJ, Burhop J. Laparoscopic highly selective vagotomy: technique and case report. Surg Laparosc Endosc. 1992 Dec;2(4):348-52.

Frantzides, C.T.: Laparoscopic Vagotomy. In Laparoscopic and Thoracoscopic Surgery. Ed. Frantzides, Mosby Year-book Inc. 1994

Frantzides CT, Carlson MA. Laparoscopic highly selective vagotomy. J Laparoendosc Adv Surg Tech A. 1997;7(3):143-6.