- Cuts branches only to body and fundus in attempt to prevent stasis
- Leaves hepatic and coeliac branches
- Leaves antral and pyloric branches intact (Nerve of Latarjet)
- Divides “crow’s feet” up to 7cm proximal to pylorus and 5cm proximal to GOJ up oesophagus including the proximal, dividing the “Criminal Nerve of Grassi” from posterior Vagus
- NB: Leaves supply to G cells
- Gastrin will increase, but no response
- Recurrence 10-15%
- Not recommended for pre-pyloric ulcers (these recur)
- Side effects
- Diarrhoea 30-70% - most resolve,
- If not can use Cholestyramine 4g/ meal – takes up to a month to act
- anion exchange resin that binds bile salts rendering them unabsorbable & inactive
- May need 10cm reversed segment jejunum interposition
- 70-100cm from ligament of Treitz
- Gastric atony
- Not seen in highly selective
- Loss of antral function will reduce ability to empty solids
- Diagnose with scintigraphy to confirm delayed emptying, contrast study & endoscopy to exclude mechanical obstruction
- Rx: Pro-kinetics