Postvagotomy Diarrhea Syndrome

Vagal innervation is an important factor in the control of pancreaticobiliary secretion and intestinal absorption. Truncal vagotomy may result in excessive small bowel secretions or bile acids with resulting diarrhea. Diarrhea occurs in up to 25% of patients following a complete (truncal) vagotomy with gastric drainage or resection (17). Less than 2% of patients have incapacitating symptoms. The syndrome is characterized by frequent watery stools, usually unrelated to meals, and occurring at night. Medical therapy includes dietary alterations with low fluid content, frequent feedings, increasing dietary fiber, and adding substances such as pectin to slow intestinal transit. Medications include cholestyramine, which may help bind bile salts, and somatostatin, which is effective in some patients. Surgical therapy is rarely recommended, but when needed, consists of interposition of a 10 cm antiperistaltic jejunal limb 100 cm distal to the ligament of Treitz (18).

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