title: A relic or still relevant: the narrowing role for vagotomy in the treatment of peptic ulcer disease.
abstract: BACKGROUND
  Given the rise of medical treatment for peptic ulcer disease (PUD), surgical treatment is necessary only in select cases and emergencies. The authors assess the current relevance of surgical vagotomy to treat PUD and its complications.
  
  
  METHODS
  Although historically significant, selective and highly selective vagotomy is very technically challenging, and highly selective vagotomy has a relatively narrow indication and high recurrence rates. Vagotomy and gastrectomy is associated with significant side effects. Two types of vagotomy remain relevant, within a narrow scope. Truncal vagotomy and pyloroplasty is safe and efficacious through a laparoscopic approach in certain emergent cases. Vagotomy and Roux-en-Y gastrojejunostomy can be used to treat severe PUD refractory to medical management.
  
  
  CONCLUSIONS
  The role of vagotomy in the management of PUD has a rich history but predated pharmacologic control of acid and understanding of the role of Helicobacter pylori in the disease. Thus, the current role of vagotomy is significantly limited. Specifically, the emergent use of truncal vagotomy is warranted for patients who are either resistant or allergic to proton pump inhibitors.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA. Electronic address: jlagoo@iupui.edu.
authors.forename: Janaka
authors.initials: J
authors.lastname: Lagoo
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Perez
mesh_terms: D017219:Gastric Outlet Obstruction / Q000601:surgery; D005763:Gastroenterostomy; D049673:History, 20th Century; D006801:Humans; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery; D010437:Peptic Ulcer / Q000150:complications / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000601:surgery; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D014481:United States; D014628:Vagotomy / Q000009:adverse effects / Q000266:history / Q000379:methods
chemical_list: D054328:Proton Pump Inhibitors
keywords: Highly selective vagotomy; Peptic ulcer disease; Proton pump inhibitors; Selective vagotomy; Truncal vagotomy; Vagotomy