TREATMENT OF BLEEDING PEPTIC-ULCER BY BILATERAL TRUNCAL VAGOTOMY VIA A TRANSPLEURAL THORACOSCOPIC APPROACH AND LAPAROSCOPIC PYLOROMYOTOMY

Six cases of recurrent bleeding duodenal ulcer were treated by bilater al truncal vagotomy via a right transpleural thoracoscopic approach an d laparoscopic pyloromyotomy at Tainan Municipal Hospital. The vagus n erves were completely transected, which was proved by pathology. Basal acid output and insulin-stimulated maximum acid output were reduced b y 68%-77% and 87%-92%, respectively, after vagotomy. On the other hand , there was no delay in gastric emptying on the basis of either patien ts' complaints or an upper gastrointestinal series of x-rays. Transple ural thoracoscopic bilateral truncal vagotomy and laparoscopic pylorom yotomy are safe, effective and offer more complete transection of the vagus nerves in treatment of complicated peptic ulcer. In addition, th is new technique provides shorter hospitalization and an earlier conva lescence.