LAPAROSCOPIC TREATMENT OF DUODENAL ULCER BY BILATERAL TRUNCAL VAGOTOMY AND ENDOSCOPIC BALLOON DILATATION

Abstract

The low morbidity and early recovery associated with laparoscopic procedures have heralded a new area for many types of surgery. In addition to the initial promising results for duodenal ulcer desease there Is a growing number of reports of gastric procedures performed laparoscopically, including omentopexy for perforated duodenal ulcer, and laparoscopic repair of full-thickness stomach injury. We have successfully performed bilateral truncal vagetomy (BTV) and balloon pyloroplasti (BPP) under laparoscope in nine patients with duodenal ulcer who were resistant to medical treatment. By the second postoperative month eight of the patients had complete healing of the ulcer, the remaining patient who had a partial pyloric stenosis before surgery, had complete pyloric stenosis due to healing of ulcer and required an open surgery. Gastro-duodenostomy (Jaboulay pytoroplasty) was done one month after the laparascopic surgery, and no vagal fibers were found during the exploration. Two patients had postoperative diarrhea and responded very well to the medical treatment.

Preliminary results showed that laparoscopic BTV and pneumatic BPP is an effective, mini-invasive treatment and results in early recovery of patients resistant to medical therapy of duodenal ulcer disease.