Thoracoscopic vagotomy for recurrent ulcer after previous gastric operation

Abstract

Background: Recurrent peptic ulcer after previous gastric operation is a difficult surgical problem and abdominal re-operation is associated with significant morbidity, mortality and recurrence rate. Methods: The authors report on five patients with recurrent ulcers who, after previous gastric operation, were treated with thoracoscopic vagotomy. Results: All patients tolerated the procedure well without complications, and the median hospital stay was 5 days. Endoscopy confirmed healing of the ulcers in all patients. Pre-operative and postoperative gastric acid studies showed a significant post-operative reduction in both basal and maximal acid output (P < 0.05). In a follow-up period of 18-33 months, one patient had a recurrent ulcer presenting with bleeding. Gastric biopsy revealed presence of Helicobacter pylori and repeated gastroscopy after a course of H. pylori eradication treatment showed a healed ulcer. The other four patients were asymptomatic. Conclusions: We conclude that thoracoscopic vagotomy is a simple and safe procedure for the treatment of recurrent ulcers after previous gastric operation, but the long-term results need further assessment.