Laparoscopic Highly Selective Vagotomy: Technical Considerations and Preliminary Results in 119 Patients with Duodenal Ulcer or Gastroesophageal Reflux Disease

Abstract

The technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow-up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.

Laparoscopic Modified Taylor Procedure in the Treatment of Duodenal Ulcer: Technique and Outcome after 5-Year Follow-Up

“…Indeed, the values of the lag phase, t ½ of gastric emptying and the percentage of solid meal retained in the stomach at 60 and 120 min postprandially and the liquid emptying studies were similar to those obtained from the healthy controls using the same nutrient meal (table 1). Moreover, our results are comparable and sometimes seem to be favorable to those obtained by other authors after treatment of chronic duodenal ulcer either with conventional [30][31][32][33][34][35], or laparoscopic surgery [8,9,[18][19][20][21]26]. …”

“…When patients are graded according to the Visick classification [28] posterior truncal vagotomy with anterior gastric stapling yields results comparable to and often likely to be better than those obtained previously after laparoscopic HSV or the modified Taylor procedure [8,9,[18][19][20][21]. Of the 16 patients included in the present study only 1 was classified as Visick III and these results are likely to be rather better [8,18] or similar [9,21] to those reported by several authors. The reduction of basal acid and peak acid output after laparoscopic posterior truncal vagotomy with anterior gastric stapling is similar to that after seromyotomy, either conventional or laparoscopic [16,21,31] and even more pronounced than after HSV [32].…”

“…Recently, HSV and alternative procedures have been performed laparoscopically [8,9,[18][19][20][21]. More of these laparoscopic methods are already standardized and the results of several series of patients showed minimal morbidity and no mortality with a recurrence rate very similar to those obtained in open surgery and compare favorably with the recurrence results after medical treatment [8,9,[18][19][20][21]. Thereafter, laparoscopic truncal vagotomy with anterior seromyotomy, using the Endo-GIA' Multifire stapler, has been our alternative procedure to the conventional operation, after the new era of laparoscopic surgery, to reduce postoperative pain, recovery time and morbidity.…”

“…The aim of this surgical technique for the treatment of duodenal ulcer is to reduce the acidic gastric secretion without impairment of the gastric motility, especially the pyloric, and to be a safe alternative to the time-consuming laparoscopic HSV [8,9], even in less experienced hands [10,36]. Recently, HSV and alternative procedures have been performed laparoscopically [8,9,[18][19][20][21].…”

“…This procedure is, however, often tedious and time-consuming [5][6][7] mainly when it is performed laparoscopically [8,9], where technical expertise (closely related to postoperative outcome [10,11] has declined sharply because of a diminishing number of surgical indications. Technical simplifications, based on intramural types of vagotomy such as seromyotomy [12][13][14] have been developed.…”