ABSTRACT
Vagotomy has almost replaced gastric resection in the treatment of chronic duodenal ulcer in most of surgical centers, and the highly selective type is a logical step in the direction of more conservatism. In the present study, open versus laparoscopic anterior highly selective vagotomy [HSV] and posterior truncal vagotomy [TV], were used for the treatment of chronic duodenal ulcer [CDU] and the results were evaluated. Anterior HSV and posterior TV were used to treat 38 patients with CDU. Twenty patients were managed by open surgery [group I], and 18 by laparoscopic surgery [group II]. Laparoscopic surgery was performed successfully in 15 patients [83%], while it failed in 3 patients [17%] and converted into open surgery. The mean operative time was 90 minutes in the open surgery group [OSG], and 150 minutes in the laparoscopic surgery group [LSG]. The mean postoperative hospital stay was 12 days in the OSG, while it was 3 days in the LSG. The basal acid output [BAO] and the maximal acid output [MAO] reduced significantly in both the OSG and LSG groups [P<0.01]. By assessment using the Visick scale, in the OSG, 14 patients [70%] were Visick grade I, 4 patients [20%] were Visick grade II, and 2 patients [10%] were Visick grade III, Using the same scale in the LSG. 12 patients [80%] were Visick grade I. one patient [7%] was Visick grade II, and 2 patients [13%] were Visick grade IV. Recurrence occurred in 2 patients [10%] of the OSG, and in one patient [7%] of the LSG. We concluded that although both open and laparoscopic surgery offers satisfactory results in the treatment of CDU, the later could be considered as a reasonable alternative. It is a minimally invasive technique with minimal operative and postoperative morbidity and short hospital stay