The vagus nerve and its vagaries.
Without any further comments we advise the surgeon performing open or laparoscopic vagotomy to know the anatomy and the vagaries of the vagus nerve. In view of the demonstration that the nerves of the greater curvature, identified as a concern in achieving a "complete" PGV, are projected from up to 20% of the nerve cell bodies of the dorsal motor nucleus of the vagus nerve in the brain stem, we believe it is appropriate to adopt the technique of EHSV as a means of avoiding the high recurrence rates reported with conventional highly selective vagotomy or proximal gastric vagotomy. When pyloric stenosis or outlet obstruction is present, anterior hemipylorectomy provides a solution. If surgeons adopt a laparoscopic approach to EHSV, they must be cognizant of all sites of preganglionic innervation, and (ideally) attempt to verify the "completeness" of vagotomy by Congo red testing. We look forward, also, to the work of Andrus and Schneider, who are evaluating alternative methods of achieving complete vagotomy.
Emory University School of Medicine, Atlanta, Georgia.
L J
LJ
Skandalakis
P E
PE
Donahue
J E
JE
Skandalakis
D006801:Humans; D013270:Stomach / Q000294:innervation; D014628:Vagotomy; D014630:Vagus Nerve / Q000033:anatomy & histology* / Q000196:embryology / Q000601:surgery*