Highly selective vagotomy
- Highly selective vagotomy (parietal cell vagotomy or proximal gastric vagotomy) involves selective division of the vagal fibers to the acid-producing parietal cell mass of the gastric fundus, while maintaining vagal fibers to the antrum and distal gut.
- The anterior and posterior neurovascular attachments are divided along the lesser curvature of the stomach, beginning approximately 7 cm from the pylorus and progressing to the gastroesophageal junction, with additional skeletonization of the distal 6 to 8 cm of the esophagus to ensure division of the criminal nerve of Grassi .
- Innervation of the antrum and pylorus is maintained because the two terminal branches of the anterior and posterior nerves of Latarjet are left intact.
