Vagotomy with Partial Distal Gastrectomy (List separately in addition to code[s] for primary procedure)

Name of the Procedure:

Common Name(s): Vagotomy with partial distal gastrectomy
Technical/Medical Terms: Truncal Vagotomy, Distal Gastrectomy, Gastric Resection

Summary

A vagotomy with partial distal gastrectomy is a surgical procedure that involves cutting the vagus nerve to reduce stomach acid production and removing the lower part of the stomach. This procedure is usually done to treat severe stomach ulcers that have not responded to other treatments.

Purpose

Medical Condition: Severe peptic ulcers, gastric outlet obstruction.
Goals/Expected Outcomes: The purpose of the procedure is to reduce stomach acid production, promote healing of ulcers, and remove any diseased portions of the stomach. This helps alleviate symptoms such as pain and prevents complications like bleeding or perforation.

Indications

Symptoms/Conditions:

• Chronic or recurrent peptic ulcer disease unresponsive to medication
• Gastric outlet obstruction preventing normal gastric emptying
• Severe gastritis
• Non-malignant gastric tumors

Patient Criteria/Factors:

• Failed medical therapy
• Recurrent ulcer bleeding or perforation
• Significant gastric scarring causing obstruction

Preparation

Pre-procedure Instructions:

• Fasting for at least 6-8 hours before surgery
• Stopping certain medications as advised by the doctor, such as blood thinners
• Performing specific diagnostic tests like endoscopy, blood tests, imaging studies to evaluate the extent of disease

Procedure Description

Step-by-Step Explanation:

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the stomach.
3. The vagus nerve is cut to reduce acid secretion.
4. The lower part of the stomach (distal part) is removed.
5. The remaining part of the stomach is reconnected to the intestine.
6. The incision is closed with sutures or staples.

Tools/Equipment:

• Scalpel, retractors, surgical staplers, laparoscopic instruments if performed minimally invasively

Anesthesia/Sedation: General anesthesia

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Surgeon (usually a gastrointestinal or general surgeon)
• Anesthesiologist
• Operating room nurses
• Surgical technician

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Reaction to anesthesia

Rare Risks:

• Dumping syndrome (rapid gastric emptying)
• Nutrient deficiencies due to reduced stomach size
• Stricture formation at surgical connection site

Possible Complications and Management:

• Leak at the surgical site managed with further surgical intervention or drains
• Persistent ulcers managed with additional medication or surgery

Benefits

Expected Benefits:

• Relief from ulcer-related symptoms
• Prevention of complications like bleeding or perforation
• Improvement in overall gastritis condition

Realization Timeline:

• Benefits can be immediate in terms of symptom relief, but full recovery and normalization of digestive function may take several weeks.

Recovery

Post-procedure Care:

• Hospital stay of about 5-7 days
• Monitor vital signs and surgical site for infection
• Gradual reintroduction of diet, starting with liquids

Expected Recovery Time:

• Full recovery typically takes 4 to 6 weeks

Restrictions/Follow-Up:

• Avoid heavy lifting for several weeks
• Follow-up appointments to monitor recovery and assess for complications

Alternatives

Other Treatment Options:

• Medication therapy including proton pump inhibitors and antibiotics
• Endoscopic interventions for bleeding ulcers

Pros and Cons:

• Medications are less invasive but may be less effective for severe cases.
• Endoscopic procedures are less invasive but may not be suitable for extensive disease or complications.

Patient Experience

During the Procedure:

• Under general anesthesia, so the patient will not feel or recall the procedure.

After the Procedure:

• Pain managed with medications
• Discomfort and pain at the incision site
• Possible nausea or changes in bowel habits initially

Pain Management and Comfort Measures:

• Administering pain relief medications
• Encouraging walking and breathing exercises to prevent complications and promote recovery