الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
The popularity and good results of Laparoscopic cholecystectomy
have persuaded surgeons to apply the minimally invasive approach to the
management of chronic duodenal ulcer disease.
Vagotomy of various types can be carried out via the laparoscopic
approach , under the same conditions as apply to other forms of
laparoscopic surgery .
Laparoscopic vagotomy according to Taylor is as effective and safe
as open vagotomy in the treatment for duodenal ulcer disease untractable to
medical therapy. This technique opens up new horizons in the treatment of
duodenal ulcer as this theraputic modality is not invasive and outcome has
been uniformly good.
In this work 42 patients were done laparoscopically as a management
for chronic duodenal ulcer disease . 26 patients were complaining from
chronic active duodenal ulcer unresponsive to medical treatment for 2
years ,4 patients were complaining from recurrent mild attacks of
haematemesis while they are on proper medical treatment, 12 patients with
cicatricial pyloric obstruction.
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Induction of pneumoperitoneum was done by either the open or the
closed method. 37 patients were done by the closed method,S patients
were done by the open method due to obesity , upper abdominal scar and
small umbilical hernia.
The average operative time was 101 minutes ranging from 60 to 150
minutes in laparoscopic posterior truncal vagotomy and anterior lesser curve
seromyotomy and it was 130 minutes ranging from 100 to 180 minutes in
laparoscopic bilateral truncal vagotomy and open gastro-jejunostomy .
Conversion to open surgery ( vagotomy and gastro-jejunostomy ) in
this work was done in one patient due to dense peri-osophageal fat
deposition with extensive vascularity.
Intra-operative difficulties was minimal III the form of : intraperitoneal
adhesion which could be dissected , excess fat in one patient
which was converted to open surgery , bleeding from the entering trocars
and it was controllable but there were no visceral bleeding.
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Post-operative pain was tolerable in all patients and all patients were
given 50 mg pathidine post-operativelly . Regain of intestinal sounds were
within 24 hours after laparoscopic posterior truncal vagotomy and anterior
lesser curve seromyotomy and within 48 - 72 hours after laparoscopic
bilateral truncal vagotomy and open gastro-jejunostomy .
Long term post-operative follow up was done clinically and
endoscopically at 4 , 8 , and 12 months intervals. Recurrence rate after
laparoscopic posterior truncal vagotomy and anterior lesser curve
seromyotomy was 3 patients out of 30 . Patients after laparoscopic bilateral
truncal vagotomy and open gastro-jejunostomy were tolerating the
operation well, one patients needed to be converted to Roux-en- Y due to
marked biliary gastritis .
Laparoscopic posterior truncal vagotomy and anterior seromyotomy
IS a procedure that has been validated by multi centre studies and by
controlled study at open surgery. It combines the rapidity and effectiveness
of a truncal vagotomy with the advantage of maintaining the gastric antral
pump with an ultraselective vagotomy.