Vagotomy is a surgery where part of your vagus nerve is removed. Until antacid medications and stomach bacteria treatments came along, this was one of the main treatments for peptic ulcer disease.
What Is the Vagus Nerve?
The vagus nerve is one of the 12 nerves that are part of your autonomic nervous system. This nervous system controls your involuntary activities like heartbeat, swallowing, stomach acid release, and the movement of food through your intestines.
The vagus nerve exits your brain through the brainstem and travels through your neck, across your chest, and into your abdomen. It plays an important role in your gut-brain connections.
When you eat, the sight, smell, and taste of food send signals to your vagus nerve. Your vagus nerve then sends signals to your stomach lining, telling it to release gastric acid.
When you have a peptic ulcer, gastric acid is continually released into your stomach, which stops the ulcer from healing.
A vagotomy, or vagus nerve surgery, used to be the main treatment for peptic ulcer disease, but is now rarely used to treat the condition. It’s used today mostly for:
- Ulcers that don’t respond to other treatments
- Pyloric stenosis, a rare condition in babies where the connection between the stomach and small intestine gets thick and narrowed
- Emergency treatment for digestive tract bleeding from a peptic ulcer or an ulcer that has burned through the intestinal wall
- Internal bleeding caused by high blood pressure in the vein from the intestine to the liver
Types of Vagotomy
There are different types of vagotomies.
Truncal vagotomy. This procedure cuts out part of the vagus nerve at the gastroesophageal junction. This is the area that connects the tube from your mouth, called the esophagus, to your stomach.
After this surgery, your stomach won’t have nerve supply, which can stop gastric acid from being released, and it can affect food movement through your intestines. Your doctor may need to do a draining procedure.
Selective vagotomy. As the name suggests, this surgery is more precise than truncal vagotomy. Only the part of the nerve that goes to the stomach is removed, and the vagus nerve connection to the gallbladder and intestine is left in place.
The technique was designed to create fewer side effects than truncal vagotomy, but later studies showed it didn't help.
Highly selective vagotomy. This procedure is also called parietal cell vagotomy and is the most precise option. It involves removing part of the vagus nerve only where it connects with the parietal cells in the stomach wall that release gastric acid.
The rest of the nerve is left there where it can still stimulate the valve that connects your stomach to your intestine. No draining procedure is needed.
Highly selective vagotomy can be done by open surgery — where doctors open a large part of your abdomen — or it can be done laparoscopically. Laparoscopic surgeries are less invasive, and involve a tube with a camera inserted through small cuts.
Vagotomy Side Effects
Every surgery has risks, especially when you’re under general anesthesia, but some of the side effects of a vagotomy depend on the type you have. Some side effects of the truncal vagotomy and selective vagotomy include:
- Cholestasis, or the stopping or slowing of bile in the gallbladder
- Delayed gastric emptying
- Dumping syndrome
- Weight loss
- Injury to the stomach, esophagus, and/or major blood vessels during surgery
- Staple line leak, where there’s an opening along the stitches that causes leaking
Highly selective vagotomy leaves you with normal stomach emptying of solids, but can cause fast liquid emptying, or dumping syndrome, because the relaxation part of the vagus nerve is affected.
Symptoms of dumping syndrome include:
- Feeling sick
- Stomach pain
Long Term Vagotomy Complications
Vagotomy can cause long-term complications, including:
- Your ulcer comes back, which happens more often with highly selective vagotomies
- Frequent gallstones
- Ulcers on the surgical area
- Increased risk of stomach cancer
These complications aren’t always caused directly by a vagotomy but come from changes to normal digestive activities.
Recovery from Vagotomy
If you have a vagotomy, you will need to stay in the hospital for several days so your doctor can monitor how you respond to the surgery. After a highly selective vagotomy, you will start fluids by mouth as soon as the evening of the surgery. After a truncal vagotomy, you’ll need to wait two to three days.
Considerations for a Vagotomy
Your doctor will likely only decide on a vagotomy if medications don’t help or you have an emergency condition. Your doctor will discuss all your options with you.