VIDEO THORACOSCOPIC TRUNCAL VAGOTOMIES - TECHNIQUE AND PRELIMINARY-RESULTS

Background/Aims: This report presents the technique and preliminary re sults of a prospective trial of videothoracoscopic bilateral truncal v agotomy without a drainage procedure in a series of selected patients having elective surgery for chronic non obstructive duodenal ulcer. Ma terial and Methods: Videothoracoscopic truncal vagotomy was performed in size patients with chronic duodenal ulcer resistant to medical trea tment. These patients undergoing neither a drainage nor a dilatation p rocedure 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 endo scopic control were studied. Results: A Videothoracoscopic approach to truncal vagotomy was performed simply with a mean operation time of 4 2 min (35-80) providing all the advantages of minimally invasive surge ry 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 sec ond month postoperatively. During the mean. follow-up period of 26 mon ths (3-38), the only symptom was moderate diarrhea which resolved spon taneously. Conclusion: Truncal vagotomy by videothoracoscopy as a simp le, surgeon independent and efficient procedure seems to be an alterna tive treatment regimen for the management of chronic duodenal ulcer in a group of selected patients. instead of routine addition. of a drain age 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 to day's circumstances.