Gastro-oesophageal reflux complicating highly selective vagotomy

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Duodenal ulcers are a common condition requiring surgical intervention.
• Highly selective vagotomy (HSV) has been employed to reduce gastric acid secretion.
• Gastro-oesophageal reflux is a potential post-operative complication.

Purpose of the Study:

• To report the incidence of gastro-oesophageal reflux following highly selective vagotomy.
• To investigate the potential cause of this reflux.
• To introduce a surgical modification to mitigate reflux.

Main Methods:

• Observation of reflux incidence in a series of patients undergoing HSV for duodenal ulcers.
• Surgical technique involved assessing and modifying the angle of oesophageal entry into the stomach.
• Routine implementation of the angle-narrowing technique in subsequent operations.

Main Results:

• A high incidence of gastro-oesophageal reflux was noted in patients treated with HSV.
• The altered angle of oesophageal entry into the stomach is hypothesized as the cause.
• Narrowing this angle during surgery is proposed as a preventative measure.

Conclusions:

• Highly selective vagotomy for duodenal ulcers is associated with a significant risk of gastro-oesophageal reflux.
• Modifying the angle of oesophageal entry during surgery may reduce the incidence of post-vagotomy reflux.
• This surgical adjustment is now a standard part of the procedure.