title: Laparoscopic vagotomy and open pyloroplasty for bleeding duodenal ulcer not controlled endoscopically.
abstract: The majority of our patients with bleeding duodenal ulcer responded to endoscopic injection treatment. However, in six patients admitted during a 2 1/2-year period, we were forced to do emergency surgery to control the hemorrhage (three with failed injection and persisting exsanguination from a brisk bleeder and three rebled soon after apparent initial hemostasis). We performed an innovative procedure: pyloroplasty was done after oversewing the arterial bleeder in the duodenum through a small transverse wound in the right upper quadrant. The wound was then closed around a 10-mm trocar sheath. With the addition of three more ports, a truncal vagotomy was completed laparoscopically. Recovery was rapid and uneventful in all six cases; postoperative pain was minimal. The mean operative time was 85 minutes. We believe that, in a selected group of patients, laparoscopic vagotomy and open pyloroplasty through an essentially extended port wound (as described in detail) is an expedient and effective procedure in the emergency setting.
authors.affiliation: Department of Surgery, Yan Chai Hospital, Tsuen Wan, Hong Kong.
authors.forename: J W
authors.initials: JW
authors.lastname: Ng
authors.forename: G H
authors.initials: GH
authors.lastname: Yeung
mesh_terms: D000328:Adult; D004381:Duodenal Ulcer / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000601:surgery*; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D015167:Vagotomy, Truncal / Q000379:methods
chemical_list: D006635:Histamine H2 Antagonists