Introduction:

Truncal vagotomy is a surgical procedure aimed at treating peptic ulcer disease (PUD), particularly when medical management and lifestyle changes have proven ineffective. The procedure involves the selective division of the vagus nerve's main branches that supply the stomach. This surgical intervention helps reduce gastric acid secretion and, consequently, promotes the healing of peptic ulcers and prevents their recurrence.

Indications:

Truncal vagotomy is primarily indicated for the following conditions:

• Peptic Ulcer Disease (PUD): It is a common indication for truncal vagotomy when ulcers are recurrent, refractory to medical treatment, or complicated by bleeding, perforation, or obstruction.
• Zollinger-Ellison Syndrome: This rare condition characterized by excessive gastric acid production due to gastrin-secreting tumors (gastrinomas) in the pancreas or duodenum may necessitate truncal vagotomy in combination with other treatments.

Surgical Procedure:

The truncal vagotomy procedure involves the following steps:

• Surgical Exposure: The surgeon gains access to the abdominal cavity through an incision, typically in the upper abdomen.
• Identification of the Vagus Nerve: The vagus nerve, which plays a crucial role in controlling gastric acid secretion, is identified near the lower part of the esophagus and upper part of the stomach.
• Selective Vagotomy: The main branches of the vagus nerve, specifically the anterior and posterior trunks, are selectively divided to reduce the stimulation of acid-producing cells (parietal cells) in the stomach.
• Possible Antrectomy: In some cases, an additional procedure called antrectomy may be performed. Antrectomy involves the removal of the lower portion of the stomach (antrum), which produces a hormone called gastrin that stimulates gastric acid secretion.
• Drainage Procedure: To maintain proper gastric emptying and prevent complications like delayed emptying (gastroparesis), a drainage procedure like pyloroplasty or gastrojejunostomy may be performed.

Outcomes and Complications:

Truncal vagotomy effectively reduces gastric acid secretion, promoting the healing of peptic ulcers and providing symptomatic relief. The success rate of the procedure is high, with a low incidence of recurrent ulcers. However, like any surgical intervention, truncal vagotomy carries some risks and potential complications, including:

• Dumping Syndrome: Rapid emptying of the stomach contents into the small intestine, leading to symptoms like abdominal pain, diarrhea, and lightheadedness after eating.
• Postvagotomy Diarrhea: Some patients may experience diarrhea due to altered gastrointestinal motility.
• Bile Reflux: Increased exposure of the stomach to bile can cause gastritis and symptoms of heartburn.
• Recurrent Ulcers: In some cases, ulcers may recur despite the surgery.
• Pyloric Stenosis: Narrowing of the pylorus (the opening between the stomach and the small intestine) may occur, leading to obstruction.

Conclusion:

Truncal vagotomy is a surgical procedure used to treat peptic ulcer disease and Zollinger-Ellison syndrome by reducing gastric acid secretion. The selective division of the vagus nerve branches helps promote ulcer healing and prevent recurrences. Although the procedure is generally successful, it is not without risks and potential complications, which should be carefully considered before recommending surgery.

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