VIDEO ENDOSCOPIC TRUNCAL VAGOTOMIES WITHOUT GASTRIC DRAINAGE

The authors report 32 patients with chronic duodenal ulcer treated by bilateral truncal vagotomy (BTV) performed via laparoscopy or thoracos copy. All cases were resistant to medical treatment and chosen with se lective indication regarding endoscopic/radiologic and laboratory exam ination for absence of pyloric obstruction and presence of hyperacidit y. Only one patient had partial pyloric stenosis preoperatively due to chronic duodenal ulcer. No drainage procedure was used after BTV, and an endoscopic pyloric balloon dilatation (PBD) was performed at the s ame time as vagotomy for 20 cases; 12 patients were followed without d ilatation as a prospective trial. Semiliquid diet and promotility medi cation were started 24 h after surgery. All patients tolerated pure tr uncal vagotomy without any problem, except for two patients: one in wh om open drainage procedure was required end one in whom PBD was perfor med. Basal acid output and peak acid output were measured the day befo re and 1 week after the operation. A mean decrease of hyperacidity was found: 70.6% for basal and 79.5% for peak acid output. Four patients suffered from moderate symptoms of diarrhea occurring intermittently a nd responded to medical treatment or recovered spontaneously. Median h ospital stay was 4.8 days (range 3-10 days). Endoscopic control perfor med for 28 patients 2 and 6 months after the operation showed healing of the ulcer. But the patient who had partial pyloric stenosis and was operated on with BTV and PBD required an open drainage procedure (Jab oulay gastrojejunostomy) in spite of repeated PBD. There was no other gastropyloric outlet obstruction in this preliminary study with mean f ollow-up of 22 months (range 6-42 months).