Shafiq ur Rehman.
Laparoscopic Vagotomy: A New Horizon in the Management of Peptic Ulcer.
J Coll Physicians Surg Pak Jan ;10(5):175-8.

With the advent of H2 receptor antagonists and Hydrogen pump inhibitors surgery for peptic ulcer disease has become a rarity. However, certain number of patients still require surgery either for one of the complications, or persistence of symptoms after prolonged medical therapy. Vagotomy is the preferred surgical treatment. With the advent of laparoscopic vagotomy there has been a revival of surgery for peptic ulcer disease. Ten patients with intractable duodenal ulcer underwent laparoscopic vagotomy, five patients had truncal vagotomy, only two had a drainage procedure whereas three were without drainage, four patients underwent posterior truncal vagotomy and anterior seromyotomy, one patient had a highly selective vagotomy using a new surgical tool, a harmonic shear. Initial results are very encouraging. Vagotomy was successfully carried out in all patients. In one patient while performing seromyotomy a gastric perforation occurred. This was closed laparoscopically, however, a laparotomy was also performed for safety reasons. All patients have remained asymptomatic with a maximum follow-up of six years. Harmonic shear expedites highly selective vagotomy making it less cumbersome and perhaps a procedure of choice in the future.

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