[Total transgastric highly selective vagotomy (author's transl)]

By replacing the transection and excision of the hiatal cardioesophageal branches of the vagus nerve including the nerve branches accompanying those arteries entering the proximal gastric fundus and the gastric branches of the nerves of Laterjet by a seromuscular incision along the lesser curvature from the incisura to the cardia continuing in an arch below the oesophagogastric junction downwards along the greater curvature to a level between the estimated entrance of the short gastric and left gastroepiploic vessels, a total transgastric highly selective vagotomy is achieved. The danger of free exposure of the mucosa is prevented by interposing a free omental graft sutured into the gap in the gastric musculature. The graft protects against complications due to regeneration of the divided vagal branches. This operation is much less extensive, less invasive and significantly more simple than HSV. Completeness of vagotomy is less invasive and significantly more simple than HSV. Completeness of vagotomy is controlled intra-operatively both a gastric pH meter and by measuring the oxygen tension of the gastric mucosa. Twelve to twenty months after applying TTrHSV the mortality was nil in only a restricted number of patients with duodenal ulcers and the morbidity was insignificant. Previous ulcer symptoms disappeared. Dumping syndrome, recurrence of ulceration and other significant complications were not observed. Data of basal and stimulated acid secretion during the 12 to 20 month period after the operation are given.