Vagotomy

Vagotomy is a surgical procedure in which selected branches of the vagus nerve to the stomach are cut in order to reduce gastric acid secretion and modify gastric motility. Historically, it was a mainstay treatment for peptic ulcer disease when medical therapy was limited or ineffective. By interrupting parasympathetic signals to the stomach, vagotomy lowers acid production and can alter gastric emptying.

There are several forms of the procedure. Truncal vagotomy involves transection of the main vagal trunk before it reaches the stomach. Selective vagotomy targets nerves to the acid-producing regions of the stomach while preserving branches to the antrum and pylorus, aiming to maintain motility. Highly selective or parietal cell–sparing vagotomy isolates and interrupts only the fibers supplying acid secretion while sparing most nonacid–secreting pathways. Procedures may be performed alone or in combination with pyloroplasty or antrectomy to facilitate gastric emptying and improve outcomes.

Indications for vagotomy have declined with the advent of proton pump inhibitors and antibiotics for Helicobacter pylori infection. It is now used only in select cases, such as chronic or refractory ulcers or certain gastric outlet problems where medical therapy is insufficient and surgical symptoms persist.

Potential complications include postvagotomy syndrome (early satiety, bloating, dyspepsia), dumping syndrome (rapid gastric emptying), diarrhea, weight loss, and bile reflux gastritis in some configurations. Advances in surgical techniques and the shift toward nonoperative management have reduced its contemporary use; when performed, it is often via laparoscopic approaches in experienced centers.