Laparoscopic treatment of peptic ulcers. A review after 6 years experience with Hill-Barker's procedure.
OBJECTIVE
This study illustrates our experience in treating duodenal ulcers by means of laparoscopy over a period of 6 years and the results after a lengthy careful follow-up.


METHODS
From October 1991 to October 1997 we submitted 35 patients, 28 men and 7 women of an average age of 51 years (range: 22-78), to vagotomy with minimally invasive access: 23 Hill-Barkers, 2 Taylors, 6 thoracoscopic truncal vagotomies, and 4 laparoscopic truncal vagotomies. Of the patients submitted to surgery with the Hill-Barker technique, 8 were resistant to medical therapy, 11 decided not to continue with long-term medical therapy, 3 assumed an irregular medical therapy, and 1 who had been suffering for a long time from an ulcerous disease required vagotomy in association with laparoscopic cholecystectomy. In 16 patients a bleeding complication preceded surgery.


RESULTS
In our experience, the average duration of the operation with the Hill-Barker technique is 40 min (range: 30-80 min), with return to normal feeding in 1 day without any disorders and return home on day 3 (range: 2-5). The patients have been followed for 3-54 months. One patient (4.3%) was lost during the follow-up. Twenty-one (91.3%) out of the 23 submitted to anterior superselective and posterior truncal vagotomy were pain and ulcer-free without medical therapy. There was only one relapse (4.3%) after 7 months where the patient underwent left thoracoscopic truncal vagotomy.


CONCLUSIONS
In our opinion, as posterior truncal and anterior superselective vagotomy using the Hill-Barker technique guarantees the same excellent results, it is preferable due to the speed and ease of performance and to the low cost compared with other procedures which take more time (e.g., Taylor's section and suture of the anterior gastric wall) and require the use of particularly expensive equipment (e.g., Gomez-Ferrer's mechanical sectioning and suturing).
Croce
E
E
1st Department of General and Thoracic Surgery, Fatebenefratelli Hospital, Milan, Italy.
Olmi
S
S
Russo
R
R
Azzola
M
M
Mastropasqua
E
E
Golia
M
M
D000328:Adult; D000368:Aged; D004381:Duodenal Ulcer / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D013906:Thoracoscopy; D014629:Vagotomy, Proximal Gastric; D015167:Vagotomy, Truncal