Vagotomy without gastric drainage laparoscopic or thoracoscopic approach

This article describes the surgical techniques and preliminary results of a prospective trial of videoendoscopic bilateral truncal vagotomy without a drainage procedure in a series of selected patients with chronic non-obstructive intractible duodenal ulcer.

Video laparoscopic and videothoracoscopic truncal vagotomy of chronic duodenal ulcer in 32 patients has been successfully performed in the Department of Surgery, Istanbul Medical Faculty Hospital. These patients undergoing bilateral truncal vagotomy (BTV) without a drainage procedure were chosen with selective indication regarding the absence of pyloric obstruction and presence of hyperacidity. Endoscopic pyloric balloon dilatation (PBD) was performed at the same stage with vagotomy only for 20 patients as a prospective trial. The results of acid secretory tests and endoscopic control were studied.

All the patients tolerated pure truncal vagotomy well under strict follow-up with semiliquid diet and promotility medication started 24 hours after surgery. The mean decrease in secretory tests for basal acid output (BAO) and peak acid output (PAO) were 70.6% and 79.5%, respectively. Endoscopic controls, 2 months after the operation, showed healing ulcers in patients who were able to be followed-up. One patient who had partial pyloric stenosis and was operated by BTV and PBD, required a drainage procedure in spite of repeated pyloric dilatation. During the mean follow-up period of 26 months (range: 10-46), the only symptom was moderate diarrhea in 4 patients, which became well with medical treatment or spontaneously.

Videoendoscopic truncal vagotomy seems to be an alternative treatment regimen for the management of chronic duodenal ulcer in a group of selected patients, as a simple, surgeon independent and efficient procedure. Instead of routine addition of a drainage procedure after truncal vagotomy, which may improve the morbidity, observation of the patient after truncal vagotomy with dietary caution supplementary to prokinetic medication may be the chosen method in some patients.