Laparoscopic highly selective vagotomy

Although the prevalence of peptic ulcer disease has not decreased, the number of surgical procedures for definitive treatment of peptic ulcer disease has diminished. While H-2 blockers are effective in healing ulcers, the incidence of recurrence, particularly in patients who have specific risk factors and do not use life-long maintenance therapy, may range from 50-90%. In an attempt to minimize the morbidity of definitive ulcer surgery, this study was undertaken to perform and evaluate highly selective vagotomy performed laparoscopically in the porcine model. Sixteen swine underwent laparoscopic highly selective vagotomy. The acute group (n = 10) underwent immediate celiotomy after the surgery. The chronic group underwent barium studies and celiotomy 6 months following surgery. In 70% of the acute group and 100% of the chronic group, nerve identification and division were accurate. Bleeding, when encountered, could be managed laparoscopically. In the chronic group, the postoperative weight gain was appropriate and barium studies were normal. This paper details the technique and results of laparoscopic highly selective vagotomy in an animal study and shows that this procedure can be safely and accurately performed. Based on this study, a clinical trial, which includes studies of acid production, long-term follow-up, and intraoperative endoscopic Congo red testing has been undertaken on recipients of laparoscopic highly selective vagotomy.