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A standard technique of proximal selective vagotomy is described (PSV) that has proved reliable and safe in a broad multicenter clinical trial. We proceed in six steps: (1) determination of the antral-fundic boundary by anatomic criteria; (2) preliminary vagomotor electrotest; (3) identification of the nerve trunks and branches to be preserved; (4) dissection of the lesser curvature; (5) dissection of the cardia and of the intraabdominal esophagus up to 6 cm above the cardia; and (6) intraoperative assessment of completeness by the vagomotor electrotest. PSV is usually carried out without a drainage procedure.
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