Highly selective vagotomy

Q) False about highly selective vagotomy? ( # Gastric Surgery MCQS(# Questions on Esophagus) 
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed

d) Crow's feet nerves are severed till below the GE junction

This Question discusses the concept of criminal nerve of Grassi and features of HSV

Ans -d

Highly Selective Vagotomy (HSV)  only divides the last part of the nerves which supply the part of stomach which produces acid.
Anterior  and posterior  nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of Grassi is branch of posterior Vagus. It should be sought and cut. This nerve derives its name from the common mistake done during vagotomy. This nerve is often missed and responsible for recurrence of symptoms of Peptic ulcer disease.
Ref sab 2oth page 1206


Criminal Nerve of Grassi is 1st branch of posterior vagus
Criminal Nerve of Grassi is from posterior vagus

Vagus Nerve branches 

  • Anterior trunk: Gives
Branch to liver GB and Bile duct and goes along the lesser curvature as the anterior nerve of Latarjet
  • Posterior Trunk:

    Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
    • Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
    • Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
    • Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter

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