[Technique and results of laparoscopic vagotomy in chronic duodenal ulcer]

Advances made in the medical treatment of duodenal ulcer disease have lead to a sharp decrease in the number of patients who are referred for operative therapy. Today surgery may be indicated in patients with chronic and recurrent ulceration following failure of H. pylori eradication regimens and in patients with no or reduced compliance. Laparoscopic vagotomy procedures may offer this select group of patients an additional benefit and comfort, if their short-term and long-term results are comparable to those achieved following conventional open vagotomy. This is a prospective study on patients who underwent laparoscopic vagotomy using two different adapted methods evaluating short-term clinical and functional results. From October 1991 through April 1994 8 patients were studied. 3 patients received an anterior seromyotomy with posterior truncal vagotomy (according to Taylor) and 5 patients underwent anterior linear strip gastrectomy with posterior truncal vagotomy (according to Gomez-Ferrer and Morris). All patients had gastroduodenoscopy, secretory analysis of basal acid output (BAO) and maximal acid output (MAO) and evaluation of their H. pylori status performed pre- and postoperatively. Median follow-up was 15 months. 5 patients were completely asymptomatic, 2 patients complained of mild bloating or reflux and 1 patient had mild diarrhea up to 6 months postoperatively. None suffered an ulcer recurrency. All remained H. pylori positive following surgery. Secretory analysis of acid production showed a 50-70% drop in BAO and MAO after vagotomy. Both vagotomy procedures described have been specifically adapted and are well suited for a laparoscopic approach. They are expedient and easy to employ. As clinical and functional data demonstrate they achieve short-term results comparable to those seen after conventional surgery.