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A vagotomy is a surgical procedure that involves removing part of or resection of the vagus nerve. ==Types== A plain vagotomy eliminates the parasympathetic supply from the stomach to the left side of the transverse colon. Other techniques focus on branches leading from the retroperitoneum to the stomach. Highly selective vagotomy refers to denervation of only those branches supplying the lower esophagus and stomach (leaving the nerve of Latarjet in place to ensure the emptying function of the stomach remains intact). It is one of the treatments of peptic ulcer. Vagotomy is an essential component of surgical management of peptic (duodenal and gastric) ulcer disease (PUD). Vagotomy was once commonly performed to treat and prevent PUD. However, with the availability of excellent acid secretion control with H2 receptor antagonists, such as cimetidine, ranitidine, and famotidine, and proton pump inhibitors (PPIs), such as pantoprazole, rabeprazole, omeprazole, and lansoprazole, the need for surgical management of peptic ulcer disease has greatly decreased. The basic types of vagotomy are: *Truncal vagotomy (TV) includes division of the main trunk of the vagus (including its celiac/hepatic branch) and denervation of the pylorus; therefore, a pyloric drainage procedure, such as pyloric dilatation or disruption (pyloromyotomy or pyloroplasty) or gastrojejunostomy, is needed. This procedure also denervates the liver, biliary tree, pancreas, and small and large bowel. *Selective vagotomy includes division of the anterior and posterior gastric nerves of Latarjet only (after celiac/hepatic branches have been given off). It also denervates the pylorus and, therefore, a pyloric drainage procedure is needed. It does not denervate the liver, biliary tree, pancreas, or small and large bowel. This procedure is rarely performed. *Highly selective vagotomy includes denervation of only the fundus and body (parietal cell-containing areas) of the stomach (also called parietal cell vagotomy). It preserves the nerve supply of the antrum and pylorus; a pyloric drainage procedure is not needed. It does not denervate the liver, biliary tree, pancreas, or small and large bowel. This procedure is also called proximal gastric vagotomy. All types of vagotomy can be performed at open surgery (laparotomy) or using minimally invasive surgery (laparoscopy). For the management of PUD, vagotomy is sometimes combined with antrectomy (removal of the distal half of the stomach) to reduce the rate of recurrence. Reconstruction is performed with gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II). It is left intact in highly selective vagotomy so the function of gastric emptying remains intact. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Vagotomy」の詳細全文を読む スポンサード リンク
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