Acute vagotomy does not augment the systemic inflammatory response in patients with peptic ulcer disease.
Recent accumulating evidence suggests that the vagus nerve modulates the response to peripheral immunologic stimuli and that intact vagal mediation decreases the systemic inflammatory response. We hypothesized that patients who had vagotomy for complicated peptic ulcer disease would be at increased risk of an enhanced systemic inflammatory response compared to patients that did not have a vagotomy as part of their operative treatment. Ninety-six patients were identified from 1985 to 2000 and their medical records were reviewed. Patients were assigned to three groups based on the performance of a truncal vagotomy: truncal vagotomy (TV; N = 62 patients), nontruncal vagotomy (NTV; N = 34 patients), or a subgroup of the TV group, acute truncal vagotomy (ATV; N = 40 patients). Operative indications in the NTV and ATV groups were perforation (94% vs 47%) and bleeding (6% vs 53%). Systemic or organ-specific complications did not differ between groups (NTV vs ATV), and the sepsis (24% vs 23%) and mortality rates (29% vs 20%) were similar. The ICU and hospital length of stay did not differ substantially among the groups. This clinical study demonstrated that acute truncal vagotomy does not increase the risk of the systemic inflammatory response in surgical patients with complicated peptic ulcer disease.
Heider
T Ryan
TR
Department of Surgery, Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, North Carolina 27599-7081, USA.
Koruda
Mark J
MJ
Farrell
Timothy M
TM
Behrns
Kevin E
KE
D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome; D015167:Vagotomy, Truncal / Q000009:adverse effects / Q000379:methods*