Laparoscopic highly selective vagotomy.
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.
Cadiere
G B
GB
Centre Hospitalier Universitaire Saint-Pierre, Universite Libre de Bruxelles, Belgium.
Bruyns
J
J
Himpens
J
J
Van Alphen
P
P
Verturyen
M
M
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