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laparoscopic vagotomy

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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.

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