Thoracoscopic truncal vagotomy.

BACKGROUND: Nowadays the only indications to truncal vagotomy is recurrent ulceration after previous gastric surgery. Truncal vagotomy allows us to obtain a reduction in acid production and to promote ulcer healing, but this technique causes pylorospasm in about 20% of cases and this requires further synchronous or metachronous pyloric drainage procedure. For this reason, videothoracoscopic truncal vagotomy is reserved to patients with gastroresection. METHODS: The authors describe 15 patients treated with videothoracoscopic truncal vagotomy. In 12 patients, a gastrojejunostomy was done according to Roux technique in 2 patients, a reconstruction according Billroth II technique and in 1 patient, a gastroduodenostomy according to Billroth I technique. RESULTS: Videothoracoscopic bilateral truncal vagotomy was done in all patients; operation time was 45 minutes. During the postoperative period there were no complications. No patients underwent medical therapy for peptic ulcer. Only in 12 patients was it possible to execute an endoscopic follow-up in a period of 3 to 4 years. In all patients the ulcer was completely healed. CONCLUSIONS: Complete vagotomy in patients who present with recurrent gastrointestinal bleeding after previous gastroresection, is associated with significant risks. Videothoracoscopic bilateral truncal vagotomy as a simple and efficient procedure seems to be an alternative treatment for the management of recurrent ulceration after previous gastric surgery for peptic disease.

A new therapeutic strategy for the eradication of Helicobacter pylori infection.

For the eradication of the Helicobacter pylori infection, authors have tested 50 HP-positive subjects (28 females and 22 males; mean age 47 years): 21 duodenal ulcers and 29 gastritis. All patients received the following treatment: omeprazole 40 mg for 30 days, azithromycin 500 mg in a single daily dose for 3 days for 2 cycles and metronidazole 250 mgx4 for 14 days. One month after the end of therapy, patients have been controlled: the HP eradication rates have been 76% (35/46), duodenal ulcer was cured in 90% (18/20). No important side-effects were reported by patients during the treatment. In conclusion the new therapeutic scheme with azithromycin represents a semplificated alternative treatment in the eradication of Helicobacter pylori.