This monograph is a summary of observations collected over the past ten years on vagal denervation of the stomach and the functional pathology of the vagotomized stomach. It is primarily a continuation of the work we (Holle and Heinrich, 1954) began with fundectomy - the prototype of proximal dener vation of the stomach. This was the starting point for the develop ment of selective proximal vagotomy (SPV). Between 1961 and 1964 the SPY technique was developed to the extent that it could be applied clinically from January 1,1964. Like most clinical innovations, the development took place in several stages. A report on the first 235 surgical cases (1961-1967) appeared in 1968 in F. Holle's Special Surgery of the Stomach, pp. 508-509, and in 1969 in Surgery of the Stomach and Duodenum by Harkins and Nyhus, 2nd edition, pp. 629-634. Since that time it has been possible to demonstrate on the basis of 1200 operated cases as well as animal experiments that the new technique we introduced represents a successful, nonresecting surgical treatment of gastric and duodenal ulcers. It is important to have a long series of clinical cases from the same source, because it is not until a large number of individual observations have been collected concern ing complications of diagnosis, indications and technique that is it possible to analyse the relationships between them.

Historical Outline

Anatomy
Functional Anatomy of the Vagus Nerves in the Upper Abdomen
Comment I: Clinical Remarks on Vagal and Sympathetic Innervation of the Stomach
Comment II: Vagal Effects on Bile Flow
Comment III: Vagal Effects on Exocrine and Endocrine Pancreatic Secretion
Histopathology
Morphology of Gastric Parietal and Zymogen Cells
The Gastrin Producing Cell
The Effect of SPV on Parietal Cells in Man
Changes in the Pyloric-Antral Nervous Tissue Accompanying Gastric and Duodenal Ulcers
Physiology and Pathophysiology of the Vagus and Gastro-intestinal Hormones
Gastric Acid Secretory Mechanisms
Effects of Vagotomy on Gastric Acid Secretion
Gastro-intestinal Hormones - their Release and Influence on Secretion and Motility
The Effect of Vagotomy on Circulating Gastrin
Experimental Research on the Effects of SPV on Gastric Secretion and Motility in Animal and Man
Effect of Proximal Gastric Resection (Fundectomy) on Gastric Secretion and Motility
Effect of SPV on Gastric Secretion in Dogs in Insulin Tests and Sham Feeding
Effect of Pyloroplasty on Gastric Secretion after SPV and SV in Dogs
Effect of Exogenous Gastrin on the SP-Vagotomized Stomach in Man
Significance of a Feeding Test with Check of Serum-Gastrin in Man and Dog
The Effect of SPV and Pyloroplasty on Pepsin Secretion in Man
Gastric Secretion and Motility after Highly Selective Sympathectomy
Advances in Clinical and Experimental Studies on Vagotomy in Japan. Preface
Indispensability of Vagal-Antral Rami for Preserving Gastric Motor Function after Vagotomy
Effects of Various Types of Vagotomy with and without Pyloroplasty on Gastric Acid Secretion in the Dog
Effect of SPV on Gastric Motility and Vitamin B12-Absorption in DU-Patients (PreliminaryReport)
Functional Classification of Vagal Afferent Discharges in the Stomach of the Dog
Acute and Long-term Effects of Vagotomy on Gastric Mucosal Blood Flow
Vagotomy and Cholelithiasis
Regeneration of the Vagus Nerve
Stress Ulcer and Unilateral Truncal Vagotomy
Etiology of the Stress Ulcer
Clinic of SP-Vagotomy
Model of the Regulation of Secretion and Motility of the Stomach as a Feedback Circuit and its Practical Application
Diagnostics and Indication
Clinical Aspects of Vagotomy
Pre- and Postoperative Secretory Tests
X-Ray Checks after SPV Combined with Various Drainage Operations
Gastric Emptying after SPV
Special Indications for Operation and its Progress through SPV
Operating Technique of SPV
Operating Technique of SPV and Pyloroplasty
Operating Technique of Pyloroplasty
Special Technique of Pyloroplasty (with Choice of Method)
Clinical Application of the Method of Operations Based on Form and Function
Clinical Results
Clinical Results. Current Procedures Combined with Vagotomy and Their Results
SPV and Pyloroplasty in Ulcer Disease
Vagotomy in Ulcer Complications
SPV in Hiatal Hernia
SPV in Cardiospasm
Postoperative Treatment and its Complications
Critique and Summary
References
Complete Review of Literature to SPV and Pyloroplasty from F. Holle and Co-Workers 1954-1973.