Selective and highly selective vagotomy with and without gastric drainage
Selective vagotomy and highly selective vagotomy are operations designed to interrupt the vagal nerve supply to the stomach either totally or partially without disturbing vagal innervation to the remaining abdominal viscera. They have been done with and without drainage procedures.1–4
In this brief review both of these operations will be described. The theoretical reasons for their use and the techniques will be discussed, and the results of laboratory studies and clinical experiences for each type of vagotomy will be summarized.
The three types of vagotomy are truncal, selective, and highly selective. In the standard or truncal vagotomy, two or more vagal trunks are divided as they enter the abdominal cavity at or below the esophageal hiatus (Fig. 1). The selective vagotomy preserves the hepatic branch of the left, or anterior vagus nerve and the celiac branch of the right, or posterior nerve, achieving total gastric denervation, but leaving hepatic, biliary, and visceral vagal fibers intact (Fig. 2). The highly selective vagotomy denervates only the proximal stomach (including the parietal cell mass) leaving antral innervation intact via the nerves of Latarjet (Fig. 3).
Even though truncal vagotomy remains the standard operation in the United States after 33 years of clinical trials, there have been theoretical and practical objections to its use since its introduction.5 These objections have been based on the premise that it is illogical and perhaps not necessary to denervate the abdominal viscera just to reduce gastric acidity. Some of these objections are based on the physiologic consequences . . .