Date of Award

7-1968

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Medical

First Advisor

Edwin H. Ellison

Second Advisor

William J. Schulte

Third Advisor

Daniel H. Winship

Fourth Advisor

Joseph C. Darin

Abstract

Vagotomy concomitant with a drainage procedure or gastric resection is an important adjunct to the field of surgery for peptic ulcer disease. Dragstedt (16, 17) advocated complete truncal vagotomy employing a transabdominal supradiaphragmatic approach; however, he found, as had others (13, 23, 42, 60), that the intra-abdominal vagal fibers were variable, ranging from two large trunks to multiple small trunks with many intercommunications. With this in mind, Griffith and Harkins (33) proposed an approach to the vagal system independent of the diaphragm. They pointed out that with total vagotomy the parasympathetic supply to the biliary tree, small intestine, and colon (as far as the middle colic vessel) is denervated as well as the stomach. Furthermore, they noted that a number of patients develop diarrhea and incurred significant weight losses following truncal vagotomy. They hypothesized that preservation of the hepatic and celiac branches of the vagal nerves may alleviate these problems. Extensive investigation and experimentation of this technique have since accumulated, but the superiority of selective vagal section over truncal division still remains somewhat of an enigma.

Many factors influence the final clinical state following definitive surgery for peptic ulcer disease. In order to study the. differences of truncal and selective vagal division, a full knowledge of the anatomic distribution of the vagus nerves, as well as a basic understanding of gastric physiology and the post-vagotomy syndrome., must first be discussed. Once this has been accomplished, a study comparing selective and truncal vagal section can then be performed.

Download

Share

COinS

Restricted Access Item

Having trouble?