Anterior Gastric Stapling Combined with Posterior Truncal Vagotomy: An Experimental Technique for Gastric Acid Reduction

Abstract

An operative technique using a mechanical stapling device has been developed to simplify proximal gastric vagotomy. A series of gastric fistula dogs underwent posterior truncal vagotomy and anterior lesser curvature stapling. The basal and pentagastrin-stimulated acid secretion was measured before surgery and 2 weeks and 3 and 9 months after surgery. During the whole period, no change in body weight was noticed. Gastric acid secretion in dogs remained low and stable during the first year after the procedure.

Laparoscopic Modified Taylor Procedure in the Treatment of Duodenal Ulcer: Technique and Outcome after 5-Year Follow-Up

“…Simplified methods of anterior gastric wall denervation include seromyotomy [16,20,21] and gastric wall stapling [15,29]. Stapling has two advantages over seromyotomy.…”

“…Stapling has two advantages over seromyotomy. The risk of perforation by too deep an incision on the one hand and of incomplete vagotomy by too superficial a seromyotomy on the other, is avoided [15,29]. Thereafter, to further reduce the perforation risk and the operative time we prefer the use of an Endo-GIA stapler device as an alternative to the combination instrument used by Lirici et al [21].…”

“…Technical simplifications, based on intramural types of vagotomy such as seromyotomy [12][13][14] have been developed. On the other hand, severing the posterior vagal trunk has been another way of obviating the less accessible dissection of the posterior gastric wall and has been performed without major sequelae [11,15,16]. Another simplified technique described by Hendrickx et al [15] combines posterior truncal vagotomy with anterior gastric stapling.…”

“…On the other hand, severing the posterior vagal trunk has been another way of obviating the less accessible dissection of the posterior gastric wall and has been performed without major sequelae [11,15,16]. Another simplified technique described by Hendrickx et al [15] combines posterior truncal vagotomy with anterior gastric stapling. These techniques offer the advantages of diminished operating time, protection of the anterior nerve of Latarget and more complete parietal cell denervation compared with HSV [16].…”

“…Furthermore, with anterior gastric stapling, perforation from too deep an incision during seromyotomy is avoided, while the completeness of intramural anterior vagotomy is guaranteed by sectioning all layers of the gastric wall. This technique has been shown to reduce gastric acid secretion adequately; radiologically and isotopically measured gastric emptying alters little [15,17]. Laparoscopic simplified alternatives to the time-consuming laparoscopic HSV such as parietal cell vagotomies (Taylor's and Hill-Barker's procedures) were already proposed to make the operation easier and faster [18][19][20][21].…”