EVALUATION OF ALTERNATIVE PROXIMAL GASTRIC-VAGOTOMY TECHNIQUES AFTER A 9-MONTH INTERVAL IN A RAT MODES

Proximal gastric vagotomy (PGV) is an accepted operation for patients with ulcers that are refractory to medical management. Results compara ble to those of standard, operative PGV have previously been demonstra ted using endoscopic chemoneurolytic injection or laparoscopic laser s eromyotomy in a porcine model. In this study, we evaluated several PGV techniques in regard to long-term effects on acid secretion, ulcer pr ophylaxis, and permanent vagal denervation in a rat model. Trans-mucos al injection of chemoneurolytic agents (cobaltous chloride, benzalkoni um chloride, and phenol) and seromyotomy by CO2 laser were performed. After 9 months, all rats received sub-serosal gastric injections of ho rseradish peroxidase (HRP) during laparotomy. Twenty-four hours later, an ulcerogenic dose of pentagastrin was administered sub-cutaneously. Three days after administration of HRP (to allow time for retrograde axonal transport and labeling of cells of the dorsal vagal nucleus wit h HRP), necropsy was performed. The pre-pyloric gastric mucosa was ins pected for ulcerogenic changes, and a Congo red solution was applied t o the gastric mucosa to map the acid-secreting areas. All PGV methods significantly diminished pentagastrin-induced ulceration when compared to sham controls. Benzalkonium chloride chemoneurolytic and laser met hods were most effective for decreasing the size of acid-secreting are as. A reduced number of HRP-stained cells in the dorsal vagal nucleus indicated permanent denervation of vagal-gastric connections by operat ive and laser techniques.