Laparoscopic highly selective vagotomy

BACKGROUND/AIMS: Ten percent of our population has had a gastroduodenal ulc er. Medical treatment heals ulcers in 90% of the cases but they recur in 50 -70% of the patients. We present a proposal of surgical treatment for patie nts with recurrent ulcer after a long-term medical treatment or whose ulcer reappears as soon as medical treatment ceases. METHODOLOGY: Thirty-three patients underwent highly selective vagotomy (HSV ) laparoscopic between April 1992 and March 1993. There were 26 male patien ts and 7 female patients aged 19-65 years (mean age: 38 years). Twenty-six patients were operated electively and preliminary medical treatment lasted an average 5.4 years (range: 0.5-26 years) and the disease had lasted 1-30 years (mean duration: 8.4 years). For patients with a chronic peptic ulcer disease, pre-operative assessment involved a recent gastroscopy, isotopic g astric study and a selection test. RESULTS: HSV proved feasible in 100% of the cases in spite of a history of previous surgery and peritonitis in patients with a perforated ulcer. There were neither conversions nor intra-operative complications. There was no m ortality or morbidity. The mean hospital stay was 2 days(range: 1-5 days) f or selectively operated patients and 7 days (range: 6-10 days) for patients operated for a perforated ulcer. Twenty-two patients were rated Visick I a nd II and 3 with Visick III after reexamining. The BAO had decreased by 61% to 89% and the MAO by 60% to 80%. CONCLUSIONS: The treatment of choice for gastro-duodenal ulcer is highly se lective vagotomy. The laparoscopic approach shortens the hospital stay and improves patient's comfort.