LAPAROSCOPIC SELECTIVE VAGOTOMY (POSTERIO R TRUNCAL VAGOTOMY AND ANTERIOR LINEAR GASTRIC RESECTION) FOR COMPLICATED DUODENAL-ULCER DISEASE

32 patients with complicated duodenal ulcer (bleeding, recurrence, per foration) were treated by laparoscopic posterior truncal vagotomy and anterior linear gastric resection in our modification (access to the p osterior vagus via the omental bursa) of the method of Gomez-Ferrer/Ta ylor. Instead of the seromyotomy along the lesser curve we resect a 1 cm broad strip out of the anterior gastric wall. In one patient with a dditional hiatus hernia the anterior vagal trunc was cut accidentally. Converted to laparotomy this case was completed as truncal vagotomy a nd pyloroplasty. No disorders of postoperative gastric emptying were f ound. 17 patients were followed up 6 weeks postoperatively. 14 showed complete healing of the ulcer, 2 patients showed healing in progress. A follow up after 12 months obtained information about 18 patients: 7 were free of symptoms, 11 complained about intermittent pains or fulln ess. 8 of these 11 patients were controlled by gastroscopy, not any ul cer or gastritis or disorder of gastric emptying could be found. We se e advantages of our method over Kathkouda's modification of Taylor's p rocedure in the simplicity of the method, the primary hemostasis and a short operating time by using the stapler. We consider our procedure a minimal invasive, quick, safe treatment for duodenal ulcer disease w ith lasting effect at reasonable cost, especially in complicated cases like recurrent ulcer, bleeding or penetrating ulcer and in noncomplia nt patients that are not suitable for medical treatment.