Lesser curve superficial seromyotomy—An operation for chronic duodenal ulcer

Abstract

Lesser curve superficial seromyotomy has been investigated in the dog and in man. The anatomical basis for the operation, which produces an easily performed denervation of the parietal cell mass, is discussed. Acid studies in the dog confirmed that the operation was capable of producing secretory inhibition in keeping with vagotomy of the parietal cell area. A consecutive series of 25 patients with chronic duodenal ulcer has been treated by lesser curve myotomy without a drainage procedure. The operation has the advantages of being easily performed and the risk of damage to the nerve of Latarjet or of ischaemic necrosis of the lesser curvature is obviated. In 20 insulin tests performed within the first month postoperatively all patients have been negative within the first 75 min and there were 4 late positive responses. Early clinical results have been encouraging, there has been no dumping or diarrhoea and all patients are well. It is suggested that further investigation of lesser curve myotomy is warranted.

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

“…This phenome non has well been documented after various forms of vagotomy in dogs [4,16]. For com parative purposes, a 6 pg/kg pentagastrin dose was used in this study throughout the whole observation period.…”

“…Taylor [16], in an analogous attempt to simplify the procedure of highly selective vagotomy, investigated lesser curve seromyotomy as a new method of intramural vagal denervation of the gastric fundus and corpus. His results in dogs as well as in 25 patients demonstrated basal and stimulated acid output reductions that were similar to those in truncal vagotomy.…”

“…To simplify the procedure of highly se lective vagotomy, techniques which dimin ish the duration of the operation time and yet adequately reduce gastric acid secretion were proposed [7,12,15,16].…”

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

“…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]. The advantages of seromyotomy, such as keeping intact the nerve of Latarget and removing the likelihood of ischemic lesser curve necrosis, are retained [14]. The stomach remains virtually closed, avoiding the risk of infection.…”

“…This procedure is, however, often tedious and time-consuming [5][6][7] mainly when it is performed laparoscopically [8,9], where technical expertise (closely related to postoperative outcome [10,11] has declined sharply because of a diminishing number of surgical indications. 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].…”