Despite their
geographical differences, there is a gradual decrease in the prevalence of
peptic ulcer disease and its complications. This may be because of the increase
in H.pylori tests and the use of more potent drugs. Current indications for
intervention in peptic ulcer complications are bleeding unresponsive to
endoscopic treatment, perforation, ulcer-related obstruction, and intensive
medical treatment. It can be considered a non-response to treatment and an
inability to exclude cancer by endoscopic diagnostic methods. After
understanding the physiological importance of the vagus nerve, discontinuation
of cholinergic stimulation has made rational vagotomy used in treating peptic
ulcer disease and its complications. Vagotomy types are truncal, selective, proximal selective, and
supradiaphragmatic. Proximal gastric vagotomy, which will emphasized here, has
become the most commonly used vagotomy method because it causes a decrease in
basal acid secretion and maximum acid output of the stomach with an effect
similar to truncal vagotomy and eliminates stasis and atony while preserving
the distal motor functions of the stomach. The operation has four steps: 1.
Mobilization of the stomach and exposure of the region. 2. Dissection of the
anterior leaf of the lesser omentum 3. Dissection of the posterior leaf of the
lesser omentum 4. Dissection of all vagal branches extending from the distal
esophagus to the stomach. In this surgery, the nerve called "crow's
foot" is the branch of the anterior vagus that provides the distal motor
functions of the stomach and the distal branches of the Latarjet nerve. It aims
to protect the vagal network and denervate all vagal branches entering the
stomach except the truncal branches. This procedure is considered a safe,
effective, and satisfactory method, as complications such as delayed gastric
emptying, postvagotomy diarrhea, and dumping syndrome, which are vagotomy
complications, are much less common. It has taken the first place in the
surgical treatment of ulcer disease and its complications.
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