Anterior lesser curve seromyotomy using a stapling device and posterior truncal vagotomy for the treatment of chronic duodenal ulcer: Longterm results

Background: Recently, gastric stapling with posterior truncal vagotomy has been performed, either by conventional or laparoscopic surgery, as an alter native to highly selective vagotomy and the Taylor procedure for the treatm ent of chronic duodenal ulcer. Our aim was to investigate the longterm effe cts after a stapling-modified Taylor procedure, conventional and laparoscop ic, on gastric secretion and emptying and on clinical indices and recurrenc e rates in patients treated for duodenal ulcer before 1994. Study Design: Thirty-one patients, aged 40 to 76 years (mean 53 years), wer e treated between 1986 and 1993, 21 by conventional and 10 by a laparoscopi c stapling-modified Taylor procedure. Outcomes were studied for gastric aci d secretion, solid and liquid gastric emptying, euterogastric reflux, endos copic findings, and clinical indices using the Visick grading. Results: Endoscopy revealed a healing ulcer in 29 patients. Two patients sh owed signs of chronic ulcerative disease with mild symptoms, without gastri tis or pyloric stenosis indicative of progressive ulcerative diathesis, and were classified as Visick III. Twenty-four patients were classified as Vis ick I and 5 as Visick II. The enterogastric reflux index ranged from 0% to 27%, and basal and peak acid output were 1.5 +/- 0.6 mmol H+/h and 12.2 +/- 6.4 mmol H+/h, respectively. The half-emptying time of solid and liquid me als was 78 +/- 9 minutes and 18 +/- 6 minutes, respectively. These results are likely to be similar to those obtained from the series of patients who underwent highly selective vagotomy or Taylor procedure and are close to th ose achieved in healthy controls. Conclusions: This modification of the original Taylor operation (convention al and laparoscopic) allows a more rapid, technically easier, and radical p erformance of the operation with excellent longterm results and should be c onsidered an effective alternative for the treatment of duodenal ulcer. (J Am Coll Surg 1999;188:623-628. (C) 1999 by the American College of Surgeons ).