Laparoscopy-assisted truncal vagotomy with antecolic anterior gastrojejunostomy for cicatricial pyloric stenosis

ABSTRACT

Duodenal ulcer is a common disease in Egypt. The management of this disease has changed dramatically. Surgery is still indicated for the complications of duodenal ulcer. Pyloric stenosis is a common complication that may result from reluctance of the ulcer patient to seek medical advice or to receive adequate treatment. From 1992 to 2006, 175 patients with cicatricial pyloric stenosis were operated on [open truncal vagotomy with gastrojejunostomy] in our center. The aim of this work is to declare the role of minimally invasive surgery in the form of laparoscopic truncal vagotomy and extracorporeal gastrojejunostomy /or treatment of cicatricial pyloric stenosis. From December 2006 to December 2007, 14 cases of cicatricial pyloric stenosis underwent laparoscopic truncal vagotomy and extracorporeal antecolic gastrojejunostomy through a small 4 cm transverse incision in the left hypochondrium. The advantages of this procedure include reduction of pain, size of the wound and incidence of incisional hernia. The results are comparable to those of a totally laparoscopic truncal vagotomy and gastrojejunostomy. Cicatricial pyloric stenosis is an absolute indication for surgery. The standard surgical approach is truncal vagotomy and gastrojejunostomy. It could be performed totally laparoscopic using either endosteplers or intracorporeal suturing. Laparoscopy- assisted truncal vagotomy with gastrojejunostomy achieves the advantages of .minimally Invasive surgery, easy anastomosis and is cost effective. This procedure is relatively easy to perform as the anastomosis is done extracorporeally. It is less expensive than the use of endostaplers. It achieves the advantage of minimally invasive surgery in a cheap manner. This is very suitable for developing countries like Egypt