Proximal gastric vagotomy: Comparison between open and laparoscopic methods in the canine model

Christine F. Kollmorgen, Seval Gunes, John H. Donohue, Geoffrey B. Thompson, Michael G. Sarr

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The authors compared open and laparoscopic proximal gastric vagotomies for efficacy of acid reduction and preservation of gastric emptying. Summary Background Data: Laparoscopic methods have been used to perform vagotomy in patients with duodenal ulcer; however, no direct comparisons are available of laparoscopic and open surgical procedures regarding acid reduction and gastric emptying. Methods: Thirty-one consecutive dogs were randomized to open proximal gastric vagotomy (OPGV; n = 11), laparoscopic anterior seromyotomy and posterior truncal vagotomy (ASPTV; n = 10), or laparoscopic proximal gastric vagotomy (LPGV; n = 10). Intraoperative endoscopic Congo red testing assured complete vagotomy. Basal acid output (BAO) and maximal acid output (MAO) during pentagastrin and insulin-induced hypoglycemia were measured with marker dilution techniques, and gastric emptying was assessed with radionuclide-labelled solid and liquid markers before and 5 weeks after operation. Results: Operative time (mean ± standard error of the mean) for OPGV was shorter compared with ASPTV and LPGV (86 ± 7 minutes vs 124 ± 7 minutes and 115 ± 7 minutes; p < 0.002). Postoperative BAO did not decrease in any group. Open proximal gastric vagotomy and LPGV, but not ASPTV, decreased MAO (p < 0.05); (after pentagastrin, OPGV from 26.4 ± 1.7 mEq/hour to 11.3 ± 0.1 mEq/hour, LPGV from 21.4 ± 1.0 mEq/hour to 6.4 ± 0.5 mEq/hour; after insulin-induced hypoglycemia, OPGV from 9.9 ± 0.5 mEq/hour to 2.2 ± 0.3 mEq/hour, LPGV from 7.9 ± 0.5 mEq/hour to 1.9 ± 0.4 mEq/hour). Gastric emptying of liquids and solids, as quantitated by the time for one half of the marker to empty (T 1/4 ) and the shape of the emptying curve, were similar before and after all three surgical procedures. Conclusions: Laparoscopic proximal gastric vagotomy was comparable to OPGV in decreasing stimulated gastric acid production without significantly altering gastric emptying. Anterior seromyotomy and posterior truncal vagotomy was less effective in decreasing MAO and required more operative time. Laparoscopic proximal gastric vagotomy has the potential to become accepted therapy for patients with duodenal ulcer managed presently with OPGV.

Original languageEnglish (US)
Pages (from-to)43-50
Number of pages8
JournalAnnals of Surgery
Volume224
Issue number1
DOIs
StatePublished - 1996

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Proximal Gastric Vagotomy
Canidae
Gastric Emptying
Acids
Truncal Vagotomy
Pentagastrin
Vagotomy
Duodenal Ulcer
Operative Time
Hypoglycemia
Insulin
Congo Red
Indicator Dilution Techniques
Gastric Acid
Radioisotopes
Laparoscopy
Dogs

ASJC Scopus subject areas

  • Surgery

Cite this

Proximal gastric vagotomy : Comparison between open and laparoscopic methods in the canine model. / Kollmorgen, Christine F.; Gunes, Seval; Donohue, John H.; Thompson, Geoffrey B.; Sarr, Michael G.

In: Annals of Surgery, Vol. 224, No. 1, 1996, p. 43-50.

Research output: Contribution to journalArticle

Kollmorgen, Christine F. ; Gunes, Seval ; Donohue, John H. ; Thompson, Geoffrey B. ; Sarr, Michael G. / Proximal gastric vagotomy : Comparison between open and laparoscopic methods in the canine model. In: Annals of Surgery. 1996 ; Vol. 224, No. 1. pp. 43-50.
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AU - Sarr, Michael G.

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N2 - Objective: The authors compared open and laparoscopic proximal gastric vagotomies for efficacy of acid reduction and preservation of gastric emptying. Summary Background Data: Laparoscopic methods have been used to perform vagotomy in patients with duodenal ulcer; however, no direct comparisons are available of laparoscopic and open surgical procedures regarding acid reduction and gastric emptying. Methods: Thirty-one consecutive dogs were randomized to open proximal gastric vagotomy (OPGV; n = 11), laparoscopic anterior seromyotomy and posterior truncal vagotomy (ASPTV; n = 10), or laparoscopic proximal gastric vagotomy (LPGV; n = 10). Intraoperative endoscopic Congo red testing assured complete vagotomy. Basal acid output (BAO) and maximal acid output (MAO) during pentagastrin and insulin-induced hypoglycemia were measured with marker dilution techniques, and gastric emptying was assessed with radionuclide-labelled solid and liquid markers before and 5 weeks after operation. Results: Operative time (mean ± standard error of the mean) for OPGV was shorter compared with ASPTV and LPGV (86 ± 7 minutes vs 124 ± 7 minutes and 115 ± 7 minutes; p < 0.002). Postoperative BAO did not decrease in any group. Open proximal gastric vagotomy and LPGV, but not ASPTV, decreased MAO (p < 0.05); (after pentagastrin, OPGV from 26.4 ± 1.7 mEq/hour to 11.3 ± 0.1 mEq/hour, LPGV from 21.4 ± 1.0 mEq/hour to 6.4 ± 0.5 mEq/hour; after insulin-induced hypoglycemia, OPGV from 9.9 ± 0.5 mEq/hour to 2.2 ± 0.3 mEq/hour, LPGV from 7.9 ± 0.5 mEq/hour to 1.9 ± 0.4 mEq/hour). Gastric emptying of liquids and solids, as quantitated by the time for one half of the marker to empty (T 1/4 ) and the shape of the emptying curve, were similar before and after all three surgical procedures. Conclusions: Laparoscopic proximal gastric vagotomy was comparable to OPGV in decreasing stimulated gastric acid production without significantly altering gastric emptying. Anterior seromyotomy and posterior truncal vagotomy was less effective in decreasing MAO and required more operative time. Laparoscopic proximal gastric vagotomy has the potential to become accepted therapy for patients with duodenal ulcer managed presently with OPGV.

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