Thoracoscopic vagotomy for recurrent ulcer after previous gastric operation.
BACKGROUND
Recurrent peptic ulcer after previous gastric operation is a difficult surgical problem and abdominal re-operation is associated with significant morbidity, mortality and recurrence rate.


METHODS
The authors report on five patients with recurrent ulcers who, after previous gastric operation, were treated with thoracoscopic vagotomy.


RESULTS
All patients tolerated the procedure well without complications, and the median hospital stay was 5 days. Endoscopy confirmed healing of the ulcers in all patients. Pre-operative and postoperative gastric acid studies showed a significant postoperative reduction in both basal and maximal acid output (P < 0.05). In a follow-up period of 18-33 months, one patient had a recurrent ulcer presenting with bleeding. Gastric biopsy revealed presence of Helicobacter pylori and repeated gastroscopy after a course of H. pylori eradication treatment showed a healed ulcer. The other four patients were asymptomatic.


CONCLUSIONS
We conclude that thoracoscopic vagotomy is a simple and safe procedure for the treatment of recurrent ulcers after previous gastric operation, but the long-term results need further assessment.
Poon
R
R
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Chow
L
L
Lim
B
B
Gertsch
P
P
D000328:Adult; D004724:Endoscopy; D005743:Gastrectomy; D005744:Gastric Acid / Q000378:metabolism; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013906:Thoracoscopy; D015167:Vagotomy, Truncal / Q000379:methods*