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Video- and Robotic-Assisted Thoracoscopic Truncal Vagotomy.

Lumeng J Yu¹, Mark W Maxfield^1,2, Oliver S Chow^1,3

¹Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.

The American Surgeon

|April 26, 2022

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Truncal vagotomy using VATS or RATS effectively treats marginal ulcers after Roux-en-Y gastric bypass (RNYGB). This surgical approach resolved symptoms in 70% and endoscopic evidence in 83% of refractory cases.

Area of Science:

Bariatric Surgery
Gastrointestinal Surgery
Surgical Endoscopy

Background:

Marginal ulcers are a complication of Roux-en-Y gastric bypass (RNYGB).
Some RNYGB patients develop ulcers refractory to medical treatment.
These ulcers can lead to bleeding or perforation.

Purpose of the Study:

To evaluate the efficacy of video- or robotic-assisted thoracoscopic (VATS or RATS) truncal vagotomy.
To assess VATS/RATS truncal vagotomy for complicated, medically refractory marginal ulcers post-RNYGB.

Main Methods:

Retrospective review of 10 patients undergoing VATS or RATS truncal vagotomy (2013-2018).
Patients had recurrent marginal ulcers post-RNYGB, refractory to medical management for a median of 3.5 months.
Follow-up included symptom assessment and, in some cases, repeat endoscopy.

Keywords:

robotic surgery thoracic surgery vagotomy

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Main Results:

70% of patients experienced symptom resolution at a median follow-up of 23 months.
83% of patients with repeat endoscopy showed no endoscopic evidence of recurrent ulcers.
Only one patient had continued symptoms, and one had endoscopic evidence of recurrence.

Conclusions:

VATS or RATS truncal vagotomy is a safe and effective treatment for complicated marginal ulcers after RNYGB.
The procedure offers significant symptom and endoscopic resolution for medically refractory cases.
This surgical option provides a viable solution after an average of 3 months of unsuccessful medical treatment.