Nerves of Latarjet

Expansion

The anterior and posterior vagal trunks run along the lesser curvature, giving branches to the stomach and ending in a fan of terminal branches, the crow’s foot, supplying the pylorus and antrum, which control gastric emptying.

The three historical operations show the anatomy in action:

• Truncal vagotomy - divides both trunks at the oesophageal hiatus. Reduces acid, but denervates the pylorus, so a drainage procedure (pyloroplasty or gastrojejunostomy) is required to prevent gastric stasis. Also denervates the biliary tree and small bowel
• Selective vagotomy - divides gastric branches only, sparing the hepatic and coeliac branches; still needs drainage
• Highly selective (proximal gastric) vagotomy - divides only the branches to the acid-secreting body and fundus, preserving the nerves of Latarjet. No drainage needed

These operations are now largely historical, superseded by Helicobacter eradication and proton pump inhibitors, but the anatomy remains a favourite illustration of structure determining function.