GASTRIC

Question 1

Truncal vagotomy

Answer 1

• Cut the L triangular ligament of liver to retract it out of way
• Expose the esophageal hiatus by incising the peritoneum at the hiatus (be careful of L inferior phrenic vessels here)
• Mobilize the esophagus, encircling it with a Penrose drain
• Anterior vagal trunk taken first, by first mobilizing 2cm of it, the clipping and cutting; excise small portion of the nerve too
• If can’t feel the posterior trunk behind the esophagus, search the posterior tissue between the esophagus and aorta
• Submit the vagal fibers for frozen section confirmation
• Search for any other major fibers and divide these too
• Do pyloroplasty