Highly selective transgastric vagotomy: preliminary report of a new procedure

The technique of preservation of the antral vagal nerve supply of the stomach and division of the gastric branches of the nerves of Latarjet remains unchanged. By replacing the transection of the hiatal cardioesophageal vagus nerve branches, including the nerve branches accompanying the arteries entering the fundus of the stomach, with a transgastric intramural transection and excision of all nerve fibers entering the fundus, a highly superselective vagotomy is achieved. Completeness of this type of vagotomy is controlled intraoperatively both by a gastric pH meter and by measuring the oxygen tension of the gastric mucosa in all regions of the stomach, particularly in the fundus and the body. The decrease in oxygen tension of the gastric mucosa below and in the vicinity of the sermuscular incision was similar to that of the rest of the fundus. One year to 18 months after application of highly selective transgastric vagotomy in 74 patients with uncomplicated duodenal ulcers, the mortality was zero and the morbidity insignificant. The previous ulcer symptoms disappeared. Dumping syndrome, recurrence of the ulcer, and other important complications were not observed. Data of the basal and stimulated acid secretion during the six- to eight-month period after the operation are given.