title: Laparoscopic highly selective vagotomy.
abstract: OBJECTIVE
  Ten percent of our population has had a gastroduodenal ulcer. Medical treatment heals ulcers in 90% of the cases but they recur in 50-70% of the patients. We present a proposal of surgical treatment for patients with recurrent ulcer after a long-term medical treatment or whose ulcer reappears as soon as medical treatment ceases.
  
  
  METHODS
  Thirty-three patients underwent highly selective vagotomy (HSV) laparoscopic between April 1992 and March 1993. There were 26 male patients and 7 female patients aged 19-65 years (mean age: 38 years). Twenty-six patients were operated electively and preliminary medical treatment lasted an average 5.4 years (range: 0.5-26 years) and the disease had lasted 1-30 years (mean duration: 8.4 years). For patients with a chronic peptic ulcer disease, pre-operative assessment involved a recent gastroscopy, isotopic gastric study and a selection test.
  
  
  RESULTS
  HSV proved feasible in 100% of the cases in spite of a history of previous surgery and peritonitis in patients with a perforated ulcer. There were neither conversions nor intra-operative complications. There was no mortality or morbidity. The mean hospital stay was 2 days (range: 1-5 days) for selectively operated patients and 7 days (range: 6-10 days) for patients operated for a perforated ulcer. Twenty-two patients were rated Visick I and II and 3 with Visick III after re-examining. The BAO had decreased by 61% to 89% and the MAO by 60% to 80%.
  
  
  CONCLUSIONS
  The treatment of choice for gastro-duodenal ulcer is highly selective vagotomy. The laparoscopic approach shortens the hospital stay and improves patient's comfort.
authors.affiliation: Centre Hospitalier Universitaire Saint-Pierre, Universite Libre de Bruxelles, Belgium.
authors.forename: G B
authors.initials: GB
authors.lastname: Cadiere
authors.forename: J
authors.initials: J
authors.lastname: Bruyns
authors.forename: J
authors.initials: J
authors.lastname: Himpens
authors.forename: P
authors.initials: P
authors.lastname: Van Alphen
authors.forename: M
authors.initials: M
authors.lastname: Verturyen
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000601:surgery; D010538:Peritonitis / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D014629:Vagotomy, Proximal Gastric