Lesser Curve Myotomy

Branches of the nerve of Latarjet run with the serosa of the stomach before penetrating the muscularis. Myotomy of the pylorus and esophagus are safe and well established procedures. Myotomy of the lesser curve of the stomach with preservation of the major vessels should denervate the parietal cell mass; this procedure has been investigated in the dog. Pre- and postoperative secretory stimulation was carried out with pentagastrin (0.375--6 micrograms/kg/hr i.v.) and insulin (0.2 units/kg). After myotomy, in response to pentagastrin, there was a marked shift to the right of the dose response curve of acid secretion and a profound inhibition of pepsin output. The insulin response in terms of acid and pepsin secretion was almost completely abolished. Secretory inhibition after lesser curve myotomy is similar so that produced by proximal gastric vagotomy. These results would appear to give the operation a sound anatomic and physiologic basis for it is not difficult to perform technically and obviates the risk of damage to the nerve of Latarjet of ischemic necrosis of the lesser curvature.