Truncal vagotomy
Truncal vagotomy involves the division of both anterior and posterior vagal trunks at the esophageal hiatus above the origins of the hepatic and celiac branches. Periesophageal dissection must include the distal 6 to 8 cm of the esophagus to ensure division of gastric vagal branches that arise from the trunks above the level of the hiatus. Thus truncal vagotomy results in denervation of all vagal nerve–supplied viscera. A drainage procedure, usually a pyloroplasty, must be performed with truncal vagotomy, because denervation of the pylorus results in impaired gastric emptying.