A midline incision may be used for a highly selective vagotomy, but some sources recommend an incision from between the left costal margin and xiphoid process to below the right costal margin.
The stomach is pulled downward - the nerves on the lesser curve usually stand out clearly. From slightly above the point of entry of the nerve of Latarjet into the antral region, an opening is made in the avascular part of the lesser omentum. The serosa is cut upwards along the lesser curve; gastric vessels are ligated and cut on route; vagal nerves are also transected. The incision is continued up to the cardia, the oesophagus is mobilized and pulled to the right, and finally nerves at the left base of the oesophagus to the fundus are isolated and divided. Finally, the last fine division of nerves at the corpus/antrum boundary is carried out; the location of this site may be aided by an intragastric pH electrode.
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