[The pathogenesis of stomach wall necrosis following selective proximal vagotomy]

Six patients with necrosis of the lesser curvature of the stomach after proximal selective vagotomy are described. The decreased circulation due to proximal selective vagotomy can lead to extensive necrosis of the lesser curvature in cases of lack of submucosal plexus, and especially in cases with stenotic arteriosclerotic collaterals. However, one must differentiate localized perforations caused by a intraoperative laceration of the gastric wall and perforations of a gastric ulcer. Renal insufficiency, hypertension, diabetes mellitus, generalized arteriosclerosis, and previous splenectomy are, in our experience, contraindications for a proximal selective vagotomy. Those cases should be treated by selective gastric vagotomy with pyloroplasty.