LAPAROSCOPIC TREATMENT OF DUODENAL-ULCER BY BILATERAL TRUNCAL VAGOTOMY AND ENDOSCOPIC BALLOON DILATATION

The low morbidity and early recovery associated with laparoscopic proc edures have shown a new direction for many types of surgery. We perfor med a laparoscopic bilateral truncal vagotomy (BTV) with pyloric dilat ation (PD) in 20 patients (11 men, 9 women, ranging in age from 32 to 56 years, with a mean age of 42 years). All patients had chronic duode nal ulcer diagnosed endoscopically, with a mean duration of symptoms o f 2.6 years (range 2-8 years). The mean length of surgery was 55 min ( range 45-90 min). The mean follow-up period was 16 months (range 3-25 months). In 1 patient, esophageal perforation occurred during the diss ection of the left vagus nerve and was sutured laparoscopically. Acid secretion tests under basal conditions and pentagastrin stimulation pr eoperatively and 1 month postoperatively showed a decrease in basal ac id output (BAO) of 76% and maximal acid output (MAO) of 84.2%. Endosco py at the second and sixth postoperative month showed healing of the u lcer in 19 of 20 patients (95%). One patient had partial pyloric steno sis due to chronic duodenal ulcer before BTV and PD and developed comp lete pyloric stenosis after the surgery. Despite repeated pyloric ball oon dilatation, he required an open drainage procedure (gas-troduodeno stomy, Jaboulay). Three patients (15%) had postoperative diarrhea and responsed very well to medical treatment. The preliminary results show ed that laparoscopic BTV with PD is a simple and effective procedure f or the treatment of chronic duodenal ulcer.