Resection of terminal vagal branches to parietal cell mass in the treatment of duodenal ulcer.

In order to completely denervate the parietal cell mass and to prevent the undesirable side effects of highly selective vagotomy, the authors devised a new and simpler modified operative procedure. First, the anterior and posterior leaves of the lesser omentum are divided from the stomach at their attachment 6 cm proximal to the pylorus to the level 2 to 2.5 cm below the esophagogastric junction. Second, a circular seromuscular incision is made at the anterior and posterior wall of the stomach from the lesser curve 2 to 2.5 cm below the cardia to the highest short gastric artery at the greater curve. Forty cases followed for an average period of 21.8 months with satisfactory postoperative results reported.