Laparoscopic modified Taylor procedure in the treatment of duodenal ulcer:Technique and outcome after 5-year follow-up

Background: Recently, gastric stapling with posterior truncal vagotomy has been performed by laparoscopic surgery, as an alternative to highly selecti ve vagotomy (HSV) and the Taylor procedure for the treatment of chronic duo denal ulcer. Aim: To investigate, after a mean 5-year follow-up, the effect of the stapling-modified laparoscopic Taylor procedure, on gastric secreti on, emptying and re-flux as well as clinical parameters and recurrence rate s in patients treated for duodenal ulcer. Methods: 16 patients, aged 38-66 years, were treated from January 1993 to January 1996 (median 60.5 months), by the laparoscopic stapling-modified Taylor procedure, using the Endo-GIA stapler device. Assessment of the results of gastric acid secretion, solid and liquid gastric emptying, enterogastric reflux, endoscopic findings and clinical parameters, using the Visick grading, was performed. Results: End oscopy found healing ulcer in 15 patients. One patient showed signs of chro nic ulcerative disease without gastritis or pyloric stenosis indicative of progressive ulcerative diathesis and was classified as Visick III. 14 patie nts were classified as Visick I and 1 as II. The enterogastric reflux index ranged from 6 to 26%, basal and peak acid output were 1.4 +/- 0.6 and 11.7 +/- 6.1 mmol H+/h, respectively. The half-emptying times of the solid and liquid meal were 82 +/- 7 and 16 +/- 6 min, respectively. These results are likely to be similar to those obtained from series of patients who underwe nt HSV or Taylor procedure and are closed to those from healthy controls. C onclusions: The laparoscopic modified Taylor procedure, using the Endo-GIA stapler device allows a more rapid, technically easier and radical performa nce of the operation with excellent long- term results and should be includ ed in the armamentarium of the treatment of chronic duodenal ulcer. Copyrig ht (C) 1999 S. Karger AG, Basel.