HOW I DO IT / HOW I DID IT SURGICAL PROCEDURES

VAGOTOMY

            OPERATIVE TECHNIQUE 

            TRUNCAL VAGOTOMY

¶Patient in supine position

¶Asepsis/antisepsis done

¶Sterile drapes placed

¶Midline incision done from xiphoid down to about 5 cm below umbilicus

¶Elevate the sternum by a Thompson retractor

¶Left lobe of the liver retracted cephalad

¶Incised the peritoneum overlying the esophagus

¶The muscles of the right and left branches of the crux identified

¶Using peanut dissector developed a groove between the esophagus and the adjacent crux, exposing the anterior 2/3 of the esophagus

¶Gently insert the right index finger  behind the esophagus and gently encircle it

¶Apply gentle caudal traction to the stomach to exposed the main trunk of the left (anterior) vagus nerve

¶Left(anterior) vagus nerve identified clamp, cut and ligated

¶Using the surgeon’s right index finger, gently encircles the lowermost esophagus from left to right, should pass over the anterior aorta.

¶Right (posterior) vagus nerve identified, clamp, cut and ligated

¶When the hiatus admits two or more fingers alongside  the esophagus

¶Approximate the muscle bundles behind the esophagus using Tevdek suture leaving a finger breadth distance between the newly constracted hiatus and esophagus

¶Hemostasis

¶Layer by layer closure of the abdomen

o       Peritoneum and fascia closed as single layer using  PG 0 continuous interlocking suture with interrupted silk 0 suture over the fascia every five continuous interlocking sutures

o       Subcutaneous tissue approximated using chromic 3-0 inverted T sutures

o       Ski9n closed by silk 3-0 interrupted sutures

¶Betadine

¶DSD

¶ Patient tolerated procedure well