LAPAROSCOPIC TECHNIQUE OF PROXIMAL SELECTIVE VAGOTOMY

Proximal selective vagotomy (PSV) is an effective, definitive therapy for peptic ulcer disease of the duodenum. Long-term studies have shown that ulcer recurrence occurs in less than 10% of patients if the oper ation is performed by an experienced surgeon. Since PSV does not influ ence gastric emptying, side effects such as diarrhea, gastric stasis o r the dumping syndrome are rare. Due to this favorable experience, PSV is our preferred technique for the laparoscopic approach to peptic ul cer disease. We have performed this operation in 13 patients. Indicati ons were chronic duodenal ulceration unresponsive to medical therapy, chronic duodenal ulceration combined with reflux esophagitis, and refl ux esophagitis due to gastric acid hypersecretion. In patients with re flux esophagitis PSV was performed in addition to an antireflux proced ure. Laparoscopic PSV can be performed more accurately than the open p rocedure since it allows for better visualization with less possibilit y of missing small vagal connections to the parietal cells such as the ''criminal nerve''. The median duration of operation was 3 hours. The re were no serious peri- or postoperative complications. The median ti me of postoperative hospital stay was a days. During the median follow -up of 27 months no recurrence of duodenal or esophageal ulceration wa s encountered and none of the patients complained of epigastric pain, diarrhea or dumping symptoms.