Last updated: 02/17/2009

A vagotomy can be performed using closed (laparoscopic) or open surgical technique. The indications for a laparoscopic vagotomy are the same as open vagotomy.

There are four basic types of vagotomy procedures:

• Truncal or total abdominal...
  
  vagotomy. The main vagal trunks are divided, and surgery is accompanied by a drainage procedure, such as pyloroplasty.
• Selective (total gastric) vagotomy. The main vagal trunks are dissected to the point where the branch leading to the biliary tree divides, and there is a cut at the section of vagus close to the hepatic branch. This procedure is rarely indicated or performed.
• Highly selective vagotomy (HSV). HSV selectively deprives the parietal cells of vagal nerves, and reduces their sensitivity to stimulation and the release of acid. It does not require a drainage procedure. The branches of Latarjet's nerve are divided from the esophagogastric junction to the crow's foot along the lesser curvature of the stomach.
• Thoracoscopic vagotomy. Performed through the third, sixth, and seventh left intercostal spaces, the posterior vagus trunk is isolated, clipped, and a segment excised.

A vagotomy is performed under general anesthesia. The surgeon makes an incision in the abdomen and locates the vagus nerve. Either the trunk or the branches leading to the stomach are cut. The abdominal muscles are sewn back together, and the skin is closed with sutures.

Often, other gastrointestinal surgery is performed (e.g., part of the stomach may be removed) at the same time. Vagotomy causes a decrease in peristalsis, and a change in the emptying patterns of the stomach. To ease this, a pyloroplasty is often performed to widen the outlet from the stomach to the small intestine.