The authors report 32 patients with chronic
duodenal ulcer treated by bilateral
truncal vagotomy (BTV) performed via laparoscopy or thoracoscopy. All cases were resistant to medical treatment and chosen with selective indication regarding endoscopic/radiologic and laboratory examination for absence of
pyloric obstruction and presence of hyperacidity. Only one patient had partial
pyloric stenosis preoperatively due to chronic
duodenal ulcer. No drainage procedure was used after BTV, and an endoscopic pyloric balloon dilatation (PBD) was performed at the same time as
vagotomy for 20 cases; 12 patients were followed without dilatation as a prospective trial. Semiliquid diet and promotility medication were started 24 h after surgery. All patients tolerated pure
truncal vagotomy without any problem, except for two patients: one in whom open drainage procedure was required and one in whom PBD was performed. Basal
acid output and peak
acid output were measured the day before and 1 week after the operation. A mean decrease of hyperacidity was found: 70.6% for basal and 79.5% for peak
acid output. Four patients suffered from moderate symptoms of
diarrhea occurring intermittently and responded to medical treatment or recovered spontaneously. Median
hospital stay was 4.8 days (range 3-10 days). Endoscopic control performed for 28 patients 2 and 6 months after the operation showed healing of the
ulcer. But the patient who had partial
pyloric stenosis and was operated on with BTV and PBD required an open drainage procedure (Jaboulay
gastrojejunostomy) in spite of repeated PBD. There was no other gastropyloric outlet obstruction in this preliminary study with mean follow-up of 22 months (range 6-42 months).