title: Laparoscopic management of acid peptic disease.
abstract: BACKGROUND
  Despite successful medical treatment to reduce acid hypersecretion and eradicate Helicobacter pylori, surgery still plays an important role in the management of complicated peptic ulcer disease. Almost all types of conventional operations available for ulcer disease have been successfully performed by the laparoscopic approach and this has become the preferred approach in tertiary centers for operative management of acid peptic disease.
  
  
  METHODS
  Between 1995 and 2004, laparoscopic management was offered to refractory or obstructive acid peptic disease patients. For intractable disease, we performed either posterior truncal vagotomy with anterior fundal seromyotomy or posterior truncal vagotomy with anterior proximal gastric vagotomy. For peptic ulcer disease complicated with gastric outlet obstruction, we carried out bilateral truncal vagotomy with gastrojejunostomy.
  
  
  RESULTS
  Two hundred sixty three patients were operated of whom 236 (89.7%) were men and the average age of the patients was 48.4 years. Thirty-two (12.2%) patients underwent posterior truncal vagotomy with anterior seromyotomy, 89 (33.8%) underwent posterior truncal vagotomy with anterior proximal gastric vagotomy, 120 (45.6%) underwent bilateral truncal vagotomy with stapled gastrojejunostomy whereas 22 (8.4%) underwent bilateral truncal vagotomy with hand-sewn gastrojejunostomy. The average operating times were 142, 110, 98, and 72 minutes, respectively. The average postoperative stay was 5.4 days.
  
  
  CONCLUSIONS
  Laparoscopic posterior truncal vagotomy with anterior proximal gastric vagotomy for refractory disease and laparoscopic bilateral truncal vagotomy with stapled gastrojejunotstomy for obstructive disease have become the standard at our institution. Regardless of the preference of individual surgeon, our results have shown that laparoscopic surgery may become the gold standard for surgical management of peptic ulcer disease.
authors.affiliation: GEM Hospital, 45 A, Pankaja Mill Road, Ramanathapuram, Coimbatore, Tamilnadu, India.
authors.forename: Chinnasamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Jani
authors.forename: Pidigu Seshiyer
authors.initials: PS
authors.lastname: Rajan
authors.forename: Karrupasamy Sendhil
authors.initials: KS
authors.lastname: Kumar
authors.forename: Madathupalayam Vellusamy
authors.initials: MV
authors.lastname: Madhankumar
authors.forename: Alfie
authors.initials: A
authors.lastname: Kavalakat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D015390:Gastric Bypass; D017219:Gastric Outlet Obstruction / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial; D015167:Vagotomy, Truncal