Complete vagotomy. The evolution of an effective technique.

In the 36 years since the reintroduction of truncal vagotomy for the treatment of duodenal ulcer, recurrent ulcer at a rate of between 7% and 12% has become accepted as the most serious long-term postoperative complication. Although techniques for performance of complete vagotomy have been described, many of these principles of technique have been either forgotten or discarded. The new techniques of vagotomy, that is, selective and highly selective vagotomy, have realerted us to the necessity of performing a careful and wide anatomic dissection of all periesophageal tissue of the esophagogastric junction.