Operating Technique of SPV and Pyloroplasty

Abstract

The most careful technique is essential SPV = selective proximal vagotomy is an operation which must be conducted with the precision of a neurosurgical technique. The criterion of success is that the patient be insulin-negative, if possible in accordance with 5 criteria (cf. p. 144, fig. 1). This goal was achieved in 3 stages of development.

• 1. 1960 to 1964: SPV of the most important ventral and dorsal branches to the corporal-fundal region was carried out in man similar to “partial vagotomy” in dogs (Griffith and Harkins, 1957). Results: Basal secretion reduced; basal residual acid often remains; stimulated secretion almost unchanged.

• 2. 1964 to 1968: SPV extended caudally and cranially up to the angulus and the cardiac crossway. Results: Basal secretion eliminated; stimulated secretion reduced by 30 to 50 %.

• 3. 1968 to 1970: SPV completed up to the cranial and caudal borderline nerves; in addition, complete removal of all connections to the His angle: Since 1970 use of intraoperative blue staining (according to LEE) for the preparatory removal of all vagal nerve elements in the subserous layer. Results: Complete elimination of all basal acid, complete insulin negativeness in 2-h tests in 71 % of cases (5 criteria); late-positive 22%; early-positive 7%. Since 1970 the technique has been standardized (cf. fig. 1–5).