Carbon dioxide laser vagotomy: Early results

Summary

Carbon dioxide (CO₂) laser may selectively destroy peripheral nerves and preserve the accompanying blood vessels within the same neurovascular bundle. In this study we examined the effects on acid secretion of CO₂ laser irradiation on the vagal distribution of the anterior wall of the stomach with posterior truncal vagotomy. Posterior truncal vagotomy and CO₂ laser anterior seromyotomy (LV) was carried out on 10 mongrel dogs. Furthermore, five dogs received posterior truncal vagotomy and anterior highly selective vagotomy as controls (HSV). Basal acid pH (BpH) and maximal acid pH (MpH) in response to pentagastrin (7.5μg/kg) were measured pre- and post-vagotomy. The mean BpH in the carbon dioxide laser vagotomy group pre-operatively was 4.01 ± 0.8 compared to 4.96 ± 1.3 post-operatively (ns). The mean MpH pre-operatively was 1.55 ± 0.6 compared to 4.17 ± 1.0 postoperatively (P < 0.05), showing a significant reduction in pentagastrinstimulated acid output following carbon dioxide laser vagotomy. In the surgical vagotomy group, the mean BpH pre-operatively was 4.17 ± 0.8 compared to 4.57 ± 1.4 post-operatively (ns). The mean MpH pre-operatively was 1.07 ± 0.2 compared to 3.92 ± 0.8 post-operatively (P < 0.05). The pre- and post-operative BpH was the same in both treatment groups, although there was no significant difference in the MApH post-vagotomy in either group. There was a greater than 50% increase in the MpH post-vagotomy in LV and HSV. The application of CO₂ laser vagotomy through an operating laparoscope should be investigated.

Key Words:

• carbon dioxide laser
• vagotomy