Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)
CPT4 code
Name of the Procedure:
Transection or avulsion of vagus nerves limited to proximal stomach (Selective Proximal Vagotomy, Proximal Gastric Vagotomy, Parietal Cell Vagotomy, Supra- or Highly Selective Vagotomy)
Summary
This surgical procedure involves cutting or removing portions of the vagus nerve that supply the proximal part of the stomach. It aims to reduce acid production and is often used to treat certain conditions like peptic ulcers.
Purpose
The procedure is designed to manage and treat peptic ulcers by decreasing stomach acid production. The main goal is to provide relief from symptoms and prevent the recurrence of ulcers.
Indications
- Chronic peptic ulcers that do not respond to medication
- Recurrent or complicated ulcers
- Patients who cannot tolerate ulcer medications
- Conditions like Zollinger-Ellison syndrome that lead to excessive stomach acid production
Preparation
- The patient will be required to fast for at least 8 hours before the procedure.
- Pre-procedure diagnostics may include blood tests, endoscopy, and imaging studies to assess the condition of the stomach and ulcers.
- A medical evaluation to review current medications and health status.
Procedure Description
- The patient is placed under general anesthesia to ensure they sleep through the surgery.
- A small incision is made in the abdomen to access the stomach.
- The surgeon identifies the branches of the vagus nerve supplying the proximal stomach.
- These nerves are carefully cut or removed while preserving those that supply other parts of the stomach and digestive organs.
- The incision is closed with sutures, and the patient is monitored as they wake up from anesthesia.
Tools, Technology, and Anesthesia:
- Scalpels, scissors, or electrosurgical instruments for nerve transection
- General anesthesia to ensure the patient feels no pain during surgery
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The surgery is performed in a hospital or a surgical center equipped for abdominal surgery.
Personnel
- Surgeons specialized in gastrointestinal surgery
- Anesthesiologists
- Surgical nurses
- Operating room technicians
Risks and Complications
- Bleeding
- Infection
- Adverse reaction to anesthesia
- In rare cases, damage to adjacent organs or tissues
- Possible postoperative issues like delayed gastric emptying
Benefits
- Reduction in stomach acid production
- Relief from ulcer-related pain and discomfort
- Decreased likelihood of ulcer recurrence
- Improved quality of life when ulcers are managed effectively
Recovery
- Hospital stay of 1-3 days post-surgery for monitoring
- Gradual reintroduction to eating, starting with liquids and progressing to solids
- Postoperative instructions including wound care, activity restrictions, and follow-up appointments with the surgeon
- Full recovery usually takes several weeks, during which patients should avoid heavy lifting and strenuous activities
Alternatives
- Medical management with acid-reducing medications (e.g., proton pump inhibitors)
- Endoscopic treatments
- Lifestyle modifications like dietary changes and stress management
- Cons of alternatives: May not be effective for all patients, especially those with severe or recurrent ulcers
Patient Experience
- The patient will be under general anesthesia during the procedure and should not feel any pain.
- Postoperative pain and discomfort are managed with medications.
- Temporary dietary restrictions and activity limitations during the recovery phase.
- Follow-up care to monitor healing and ensure the success of the procedure.
Pain Management and Comfort Measures:
- Postoperative pain medications
- Guidance on diet and physical activity to promote healing and minimize discomfort