The hiatal region of the stomach is exposed by an upper right paramedian incision extending to the xiphisternum. The wound is firmly retracted and the left lobe of the liver displaced upwards and to the right in order to gain good visibility.
Where the oesophagus meets the stomach, the peritoneum is incised and dissected away. The anterior vagus should be readily visible at this point; 2cm of it are excised, the cut ends are coagulated with diathermy and are ligated.
The oesophagus is then mobilized by blunt dissection so that a rubber tube can be passed around it. Using the latter to lever the former away from the aorta, the posterior vagus can be felt as a prominent cord. As with the anterior nerve, it is grasped, cut, diathermied and ligated. This almost eliminates the chance of regeneration.
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