Truncal vagotomy without drainage: Are there long-term concerns?

Panelists at SAGES 2013 suggested that inadvertent vagotomy was the cause of the bloating, diarrhea, and delayed gastric emptying that is sometimes seen after complex foregut reconstructions that require extensive esophageal dissection. Is it correct to ascribe these symptoms to vagotomy and imply that a drainage procedure should always accompany truncal vagotomy? To examine the long-term sequelae of truncal vagotomy alone, the present report examines clinical outcomes of 49 patients who had truncal vagotomy without drainage at the time of placement of an adjustable gastric band.

Forty-nine patients underwent truncal vagotomy with laparoscopic adjustable gastric banding in an Investigational Review Board approved clinical trial to determine whether the addition of a vagotomy would increase weight loss when compared to gastric banding alone. The details of this trial were presented at SAGES in 2010 [1]. The patients in this study have been followed for over 5 years.

Forty-nine patients have been followed for a mean of 5.6 years. All except one have experienced a loss of hunger and cessation of gastric borborygmus. One patient showed mild delayed gastric emptying when evaluated for GERD. None of the patients experienced intractable diarrhea.

These outcomes do not support the prevailing surgical recommendation and dogma that vagotomy should always be accompanied by a drainage procedure. Furthermore, these outcomes would suggest that it is misleading to ascribe inadvertent vagotomy as the cause of the bloating, diarrhea, and delayed gastric emptying that may occasionally be reported by patients after difficult esophageal dissections.