Laparoscopic vagotomy is a recently pioneered method of treating peptic ulcer disease. Three techniques have been suggested:
- anterior lesser curve seromyotomy and posterior truncal vagotomy:
- a pneumoperitoneum is created and 5 cannulae inserted across the abdomen
- the lesser omentum is dissected
- the peritoneum and right crus are dissected from the oesophagus using a diathermy hook
- the posterior vagus is identified and transected between two clips
- the seromyotomy is produced by the diathermy hook incising at the same time as forceps retract the edges
- the seromyotomy is sealed with suture
- posterior truncal vagotomy and selective anterior vagotomy:
- the set-up is similar to that just described and the posterior truncal vagus is divided in a similar way
- the serosa on the lesser curve of the stomach is opened in order to show individual branches of the vagus under magnification
- branches to the gastric antrum are preserved whereas those to the cardia are not
- truncal vagotomy combined with pneumatic dilatation of the pylorus:
- both anterior and posterior vagal nerves are divided
- to guard against problems with gastric emptying, a balloon is endoscopically placed within the pylorus and inflated to a pressure adequate to partially rupture oblique and circular muscle
Patients generally return home after five days and are back to work in ten.