Abstract

Background: Highly selective or proximal gastric vagotomy is one of the definitive treatment for gastric ulcers. The results of this operation in comparison to truncal vagotomy is well appreciated by the surgeons. On the contrary incomplete and inadequate performance of this procedure results in recurrence of ulcer, post vagotomy diarrhoea and dumping syndrome. Knowledge about the normal and abnormal patterns of the anterior and posterior gastric nerves is imperative to the surgeons performing highly selective vagotomy. Most studies of this region have been performed on western population and the perspective of truncal and highly selective vagotomy is based on western literature only. However Indian studies regarding this one, are only few and far in-between.

Aims & Objective: To study the variations of anterior of Latarjet & its implication in surgical treatment of peptic ulcer.

Materials and Methods: This nature of study on Indian population in this part of the country is an initiative. 55 stomach specimens were utilized for the study. The present study was divided in to 3 parts: (i) Cadaveric specimens – 12 in numbers; (ii) Autopsy specimens – 40 in numbers; and (iii) Foetal Specimens – 3 in number. The anterior gastric nerve was dissected out from the level of commencement to the level of termination by dissection method. The branching pattern, plexus formation and crow’s foot appearance at the level of termination of anterior gastric nerve were studied. Results of present study were statically analyzed & compared with the findings of previous research workers.

Results: The study of pattern of the anterior nerve of Latarjet in the present study showed wide variations in terms of branching pattern, plexus formation and crow’s foot appearance.

Conclusion: The discussion emphasises the most important anatomical details relevant to the achievement of adequate highly selective vagotomy. Knowledge of these variations is of great importance for the surgeons performing highly selective vagotomy to achieve better results.

Key words: Vagotomy; Selective & Highly-Selective Vagotomy; Truncal Vagotomy; Anterior Gastric Nerve