Duodenal ulcer disease and gastric cancer: vagotomy, drainage and resection

Laparoscopic adaptation of highly selective vagotomy procedures associated with no mortality, low morbidity and no reports of diarrhoea and dumping syndrome has been reported. Although experience to date with these procedures is limited, they hold the promise of being a viable alternative for patients refractory to medical therapy or for those non-complaint with long-term maintenance pharmacologic treatment. Simple closure of an acute perforated ulcer has also been accomplished laparoscopically. In performing laparoscopic surgical procedures for duodenal ulcer disease, the relief of symptoms appears similar to that reported following comparable open procedures but with the advantages of diminished postoperative pain and disability. Moreover, the use of angled endoscopes and the magnification afforded by laparoscopy greatly facilitate the identification and transection of small vagal fibres adjacent to the oesophagus.