LAPAROSCOPIC TRUNCAL VAGOTOMY AND GASTROENTEROSTOMY FOR PYLORIC-STENOSIS

BACKGROUND: Gastric outlet obstruction secondary to chronic duodenal u lceration is an indication for surgery as conservative management with balloon dilatation frequently fails. The standard operation is trunca l vagotomy and a drainage procedure. However, development of minimally invasive surgery has revolutionized the surgical approach to this cli nical problem. METHODS: Twelve male patients with pyloric stenosis sec ondary to duodenal ulceration underwent laparoscopic truncal vagotomy and gastrojejunostomy. The perioperative and long term outcome of this group of patients were analyzed. RESULTS: The median operating time w as 210 (range 180 to 240) minutes. Median postoperative stay was 6 (ra nge 4 to 41) days. Conversion to laparotomy was necessary in one patie nt. Delayed gastric emptying occurred in two patients but resolved on conservative measures. At a median postoperative followup of 6 (range 1 to 12) months all patients had a good symptomatic outcome (Visick gr ades I or II). CONCLUSIONS: Laparoscopic truncal vagotomy and gastroje junostomy is a feasible technique. Intermediate followup shows good sy mptomatic results when used for pyloric stenosis.