Vagal Function

The vagus nerve is the longest of the cranial nerves, and it has an extended distribution with branches to the cervical, thoracic, and abdominal regions. It has fibers that are somatic and visceral afferent fibers that innervate the mucosa of the stomach and play a major role in the cephalic phase of gastric acid secretion by releasing

Figure 10-1 Anatomy of the vagus nerve on the lower esophagus and stomach. (From Lawrence, P.F.: Essentials of General Surgery. Philadelphia, Lippincott, Williams, & Wilkins, 2000.)

Figure 10-1 Anatomy of the vagus nerve on the lower esophagus and stomach. (From Lawrence, P.F.: Essentials of General Surgery. Philadelphia, Lippincott, Williams, & Wilkins, 2000.)

Vagus Nerve The Rectum

Figure 10-2 Illustrations of the high degree of variability in vagus nerve distribution along the lower esophagus. (From Partipilo, A.V.: Surgical Technique and Principles of Operative Surgery. Philadelphia, Lea & Febiger, 1949.)

Figure 10-6 Supradiaphragmatic vagotomy is accomplished through a thoracotomy and involves transecting the vagus nerves just above the diaphragm. (From Dragstedt, L.R.: Vagotomy for gastroduodenal ulcers. Ann. Surg., 122:973, 1945.)

Figure 10-11 Both anterior and posterior vagal trunks are encircled with vessel loops before beginning the dissection. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)

Figure 10-12 The lesser omentum is excised close to the lesser curve, and the small vessels extending to the lesser curve are clamped, divided, and tied. The nerves are found within this neurovascular bundle. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)

Figure 10-13 The dissection and nerve transections extend from the "crow's foot" inferiorly to the diaphragm superiorly, making certain the main trunk is not injured. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)

Figure 10-14 After the branches of the anterior vagus are divided in serial fashion, the branches of the posterior vagus are taken in similar fashion until the lesser curve of the stomach is devascularized from the "crow's foot" to the esophagus. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)

Figure 10-15 After incisions in the lesser omentum and peritoneum at the angle of His, blunt dissection with the index finger encircles the esophagus, and a drain is placed for retraction. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)

Anterior Vagal Trunk
Figure 10-17 After identification of the main anterior vagal trunk below the hepatic branch, the main branch is clipped and divided, and a section is resected. (From Maingot, R.: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)
Figure 10-19 The main posterior vagal branch is clipped and a section is resected, preserving the celiac branch. (From Maingot, R: Abdominal Operations. New York, Appleton-Century-Crofts, 1980.)
Bibliography

Amdrupk, E., and Jensen, H.E.: Selective vagotomy of the parietal cell mass preserving innervation of the undrained antrum: A preliminary report of results in patients with duodenal ulcer. Gastroenterology, 59:522, 1970. Beaumont, W.: Further experiments on the case of Alexis St. Martin, who was wounded in the stomach by a load of duck shot, detailed in the Recorder for January 1825. Med. Recorder, 9:94, 1826. Csendes, A., Maluenda, F., Braghetto, I., et al.: Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Am. J. Surg., 166:45, 1993. Dittrich, K., Blauensteiner, W., Schrutka-Kolbl, C., et al.: Highly selective vagotomy plus jaboulay: A possible alternative in patients with benign stenosis secondary to duodenal ulceration. J. Am. Coll. Surg., 180:654, 1995. Doberneck, R.: Limited operation for bleeding or perforated gastric ulcer in high risk patients. Am. Surg., 59:472, 1993.

Emas, S., and Eriksson, B.: Twelve-year follow-up of a prospective, randomized trial of selective vagotomy with pyloroplasty and selective proximal vagotomy with and without pyloroplasty for the treatment of duodenal, pyloric, and prepyloric ulcers. Am. J. Surg., 164:4, 1992.

Emas, S., Grupcev, G., and Eriksson, B.: Six-year results of a prospective randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers. Ann. Surg., 217:6, 1993.

Johnston, D., and Walkinson, A.R.: Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer. Br. J. Surg., 57:289, 1970.

Koruth, N.M., Dua, K.S., Brunt, P.W., et al.: Comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty: Results at 8-15 years. Br. J. Surg., 77:70, 1990.

Latarjet, A., and Wertheimer, P.: Quelques resultats de l'innervation gastrigue. Presse Med., 2:1993, 1923.

Laws, H., and McKernan, J.B.: Endoscopic management of peptic ulcer disease. Ann. Surg., 217:548, 1993.

Modlin, I.M.: From Proul to the proton pump—A history of the science of gastric acid secretion and the surgery of peptic ulcer. Surg. Gynecol. Obstet., 170:81, 1990. Robles, R., Parilla, P., Lujan, J.A., et al.: Long-term follow-up of bilateral truncal vagotomy and pyloroplasty for perforated duodenal ulcer. Br. J. Surg., 82:665, 1995. Valen, B., Dregelid E., Tonder, B., et al.: Proximal gastric vagotomy for peptic ulcer disease: Follow-up of 483 patients for 3 to 14 years. Surgery, 110:824, 1991. Weinberg, J.B., Stempien, S.J., Movius, H.J., et al.: Vagotomy and pyloroplasty in the treatment of duodenal ulcer. Am. J. Surg., 92:202, 1956. Wyman, A., Stuart, R.C., Enders, K.W., et al.: Laparoscopic truncal vagotomy and gastroenterostomy for pyloric stenosis. Am. J. Surg., 171:600, 1996.

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