Anterior highly selective vagotomy with posterior truncal vagotomy: A simple technique for denervating the parietal cell mass

Abstract

Abstract Anterior highly selective vagotomy with posterior truncal vagotomy was performed in a consecutive series of 20 patients with uncomplicated chronic duodenal ulcer. After identification of the vagal trunks the anterior leaf of the lesser omentum was separated from the lesser curve of the stomach, carefully preserving the anterior nerve of Latarjet. The distal extent of the dissection was from a point approximately 7–8 cm from the pylorus. After ensuring that all branches of the anterior nerve passing to the lesser curve had been severed, the trunk of the posterior nerve was divided and a segment removed. The lower 6–7 cm of oesophagus were cleared of nerve fibres. All the patients recovered well from the operation and none suffered from prolonged gastric stasis in the postoperative period. Fourteen patients are well and free of symptoms (follow-up 3–15 months). Four patients have a sense of epigastric fullness and one of these vomits occasionally. Three patients have been troubled periodically by diarrhoea and one has ulcer-type pain although no recurrence has been seen on endoscopy or on barium meal examination. One week after surgery the mean percentage reduction was 73 per cent in basal acid output and 65 per cent in peak acid output after stimulation with pentagastrin. Five of the patients had late positive insulin tests; 3 of these were the first 3 patients in the series. The other patients were insulin negative. In 10 patients the pattern of gastric emptying of a radionuclide-labelled meal 6 months after surgery was compared with that of 23 controls. The mean half-emptying time was similar in the two groups (71·7 ± 10·1 min v. 71·3 ± 3·8 min). It is concluded that this new and simpler operation is technically feasible and it may be worth a cautious trial in centres with a special interest in this type of surgery.