MINIMAL ACCESS SURGERY - THE RENAISSANCE OF GASTRIC-SURGERY

Peptic ulcer surgery has been revitalized by the introduction of minim al access techniques for surgery of chronic and perforated peptic ulce r. A wide range of vagotomies, including truncal vagotomy, anterior le sser curve seromyotomy with posterior truncal vagotomy and proximal ga stric vagotomy, have been performed laparoscopically. Short-term (two- 24 month) follow-up of laparoscopic anterior seromyotomy with posterio r truncal vagotomy cases has been promising, but long-term follow-up i s required to confirm these early good results. Laparoscopic repair of perforated peptic ulcers has also been described. Initial reports of laparoscopic gastrojejunostomy and Billroth II partial gastrectomy hav e also appeared. These procedures are technically very demanding and a re currently being performed in only a few ''centers of excellence'' a round the world. Cost-benefit analyses of medical treatment with proto n-pump inhibitors versus laparoscopic vagotomy are necessary to determ ine which form of treatment is more economical in the long run. Criter ia for patient selection need to be defined and substantiated by audit of outcome.