MINIMAL ACCESS GASTRODUODENAL SURGERY

Considerable advances are occurring in the application of laparoscopic techniques to gastrointestinal and hepatobiliary disorders. Following studies in experimental animals, surgeons with an interest in gastrod uodenal disease have now introduced laparoscopic techniques into curre nt surgical practice. Elective intervention for peptic ulcer disease i s currently being established, particularly in patients with proven ne gative Helicobacter pylori (HP) status, or when eradication has proved unsuccessful with various drug regimens. In addition, emergency lapar oscopic intervention for perforation is gaining acceptance, with or wi thout a definitive anti-ulcer procedure. Therapeutic endoscopy for ble eding peptic ulcer may well be followed by anti-ulcer laparoscopic sur gery in selected patients. Laparoscopic techniques have been utilized for the treatment of Mallory Weiss tear, congenital hypertrophic pylor ic stenosis, Dieulafoy's lesion, gastric trauma or volvulus and benign gastric tumours. More ergonomic instruments are required before lapar oscopic gastric resection becomes more widely acceptable. It is essent ial that objective evaluation of variations on vagotomy themes be unde rtaken in prospective clinical trials and that the safety and efficacy of gastric resection procedures be substantiated if this renaissance is to revolutionize gastroduodenal surgical practice.