Video thoracoscopic truncal vagotomies: technique and preliminary results

This report presents the technique and preliminary results of a prospective trial of videothoracoscopic bilateral truncal vagotomy without a drainage procedure in a series of selected patients having elective surgery for chronic non obstructive duodenal ulcer.

Videothoracoscopic truncal vagotomy was performed in six patients with chronic duodenal ulcer resistant to medical treatment. These patients undergoing neither a drainage nor a dilatation procedure supplementary to bilateral truncal vagotomy were chosen with selective indication regarding the absence of pyloric obstruction and presence of hyperacidity. The results of acid secretory tests and endoscopic control were studied.

A Videothoracoscopic approach to truncal vagotomy was performed simply with a mean operation time of 42 min (35-80) providing all the advantages of minimally invasive surgery such as low morbidity and early recovery. The mean decrease of peak acid output was 77.4% and the ulcer healed without any gastric stasis symptoms or signs as compared with the endoscopic controls at the second month postoperatively. During the mean follow-up period of 26 months (3-38), the only symptom was moderate diarrhea which resolved spontaneously.

Truncal vagotomy by videothoracoscopy as a simple, surgeon independent and efficient procedure seems to be an alternative treatment regimen for the management of chronic duodenal ulcer in a group of selected patients. 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 today's circumstances.