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04-21-2008, 04:00 PM
m Types:
1- Trunkal vagotomy:
We cut both anterior and posterior vagi at the lower end of the oesophagus which results in denervation of the stomach and abdominal viscera. Drainage operation must be done due to atony of the stomach with failure of dilatation of the pyloric sphincter® fullness, foul eructation, vomiting. Sluggish movement of the intestine causes flourishment of the bacterial flora which causes diarrhea.
2- Selective Vagotomy:Preservation of hepatic and coeliac branches makes complications less but recurrence is higher.
3- Superselective Vagotomy:
We preserve the nerve to pyloric sphincter "Nerve of Laterjet".
No need for drainage operation as the pyloric sphincter is functioning.
4- Posterior truncal vagotomy with anterior seromyotomy:
This technique is similar to superselective vagotomy with more easy and accurate parietal cell vagotomy through cutting of vagal branches in the stomach wall and preservation of the crow’s foot of the nerve of Laterjet.
The vagotomy operations now can be performed through laparoscopic or thoracoscopic approaches with more accuracy and less postoperative morbidity.
Recurrence after vagotomy is 5 : 10% but it is simple operation with low mortality.


Drainge Operations
1- Gastrojejunostomy:
Ä Technique: Posterior, retrocolic, isoprestaltic, no loop anastomosis. It may be done alone for treatment for cases with hypoacidity and for palliative bypass.
Ä Advantage: anastomosis away from the site of ulcer adhesion.
ÄDisadvantage: Bypass the normal pathway of food which diminish duodenal reflexes, hormone secretions and iron and calcium absorption.







2- Pyloroplasty:
Longitudinal incision closed transverse not recomended in cases with cicatritial obstruction.
Ä Advantage: Preserve normal anatomy.
Ä Disadvantage: Adhesions may interfere with surgery.
3- Antrectomy.
SOURCE: DR. AYMAN SALEM'S BOOK
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