Laparoscopic modified taylor procedure in the treatment of duodenal ulcer: technique and outcome after 5-year follow-up.
BACKGROUND
Recently, gastric stapling with posterior truncal vagotomy has been performed by laparoscopic surgery, as an alternative to highly selective vagotomy (HSV) and the Taylor procedure for the treatment of chronic duodenal ulcer.


OBJECTIVE
To investigate, after a mean 5-year follow-up, the effect of the stapling-modified laparoscopic Taylor procedure, on gastric secretion, emptying and reflux as well as clinical parameters and recurrence rates in patients treated for duodenal ulcer.


METHODS
16 patients, aged 38-66 years, were treated from January 1993 to January 1996 (median 60.5 months), by the laparoscopic stapling-modified Taylor procedure, using the Endo-GIA stapler device. Assessment of the results of gastric acid secretion, solid and liquid gastric emptying, enterogastric reflux, endoscopic findings and clinical parameters, using the Visick grading, was performed.


RESULTS
Endoscopy found healing ulcer in 15 patients. One patient showed signs of chronic ulcerative disease without gastritis or pyloric stenosis indicative of progressive ulcerative diathesis and was classified as Visick III. 14 patients were classified as Visick I and 1 as II. The enterogastric reflux index ranged from 0 to 26%, basal and peak acid output were 1.4 +/- 0.6 and 11.7 +/- 6.1 mmol H(+)/h, respectively. The half-emptying times of the solid and liquid meal were 82 +/- 7 and 16 +/- 6 min, respectively. These results are likely to be similar to those obtained from series of patients who underwent HSV or Taylor procedure and are closed to those from healthy controls.


CONCLUSIONS
The laparoscopic modified Taylor procedure, using the Endo-GIA stapler device allows a more rapid, technically easier and radical performance of the operation with excellent long- term results and should be included in the armamentarium of the treatment of chronic duodenal ulcer.
Petrakis
I
I
Department of General Surgery, University Hospital of Herakleion, University of Crete, Herakleion, Greece.
Vassilakis
S J
SJ
Vrachassotakis
N
N
Koutsoumpas
V
V
Chalkiadakis
G
G
D000328:Adult; D000368:Aged; D004381:Duodenal Ulcer / Q000473:pathology / Q000601:surgery*; D004383:Duodenogastric Reflux / Q000503:physiopathology; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism; D005746:Gastric Emptying; D006801:Humans; D010535:Laparoscopy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012016:Reference Values; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing