Postvagotomy dysphagia

Of the complications occurring after vagotomy, dysphagia has not been considered a major problem. Nevertheless, it does occur, after all types of vagotomy. In 1947, Moses described the first patient with this condition. The incidence of dysphagia following vagotomy varies, with reports ranging from 0% to 37%, probably a reflection of lack of uniform investigation of this problem. The mechanism of postvagotomy dysphagia can usually be attributed to one of the following: an unrecognized preoperative esophageal disorder, temporary neurogenic or hormonal imbalance, transient periesophageal inflammatory reaction, periesophageal fibrosis or reflux esophagitis. The principle of treatment for this complication is conservative, by dilatations. If prompt response to dilatations is not obtained, operation with division or excision of the stenotic esophagus should be done. Three cases of persistent dysphagia after truncal vagotomy are reported, with successful treatment: one, by dilatation, and two, by operation. According to experience here plus literature review, surgical trauma to the periesophageal tissue during vagotomy is concluded to be the most important factor in persistent postvagotomy dysphagia. Avoidance of rough dissection during operation may be the best method to decrease the incidence of this complication.