Laparoscopic vagotomy for duodenal ulcer - Tips From Other Journals

Date: August, 1991

Laparoscopic techniques are being applied to an increasing number of surgical procedures that traditionally involved laparotomy. Katkhouda and Mouiel describe their experience with a new procedure using laparoscopy for selective vagotomy in the treatment of chronic duodenal ulcer. They performed a modified truncal right vagotomy and anterior lesser curvature seromyotomy under videocoelioscopy in 10 patients in a hospital in France.

The technique involves using laparoscopic instruments to identify and divide the right vagus nerve and perform a seromyotomy of the anterior lesser curvature of the stomach (see figure). Because the examining laparoscope is attached to a magnifying video camera, the vagus nerve and blood vessels are more easily identified with this technique than with direct visualization during conventional laparotomy. Following nerve division, a seromyotomy is carried out at a distance of 1.5 cm from the lesser curvature and is extended to 6 cm from the pyloric muscle. Methylene blue dye is instilled into the gastric pouch to detect any mucosal perforation during seromyotomy. The seromyotomy is then sealed with either a fibrin preparation or is sutured with an overcast seam.

The 10 patients undergoing the procedure ranged in age from 19 to 54 years (mean age: 32 years). All of the patients had longstanding duodenal Ulcer, with a mean duration of symptoms of 3.8 years. The mean number of ulcer recurrences after medical treatment was 2.8.

In all of the patients, a satisfactory reduction in acid production was achieved, even after stimulation with insulin. The mean duration of the procedure was 60 minutes. No morbidity or mortality occurred. All of the patients were able to return to work within 10 days. Two months after surgery, nine patients had complete healing of the ulcer, and one had a small ulcer scar. None of the patients had abdominal complaints.

The authors believe that the new surgical technique is safe and effective in the treatment of chronic duodenal ulcer. The procedure will reduce postoperative pain and discomfort and will allow patients to rapidly return to normal activities. The authors caution that potential candidates must be carefully selected and that the surgical team must be prepared to convert the procedure to laparotomy if difficulties are encountered. (American Journal of Surgery, March 1991, vol. 161, p. 361.)

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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