Article Sidebar

Submitted
June 5, 2021
Accepted
June 14, 2021
Published
June 15, 2021
Download
Statistic
Read Counter : 679

Downloads

Download data is not yet available.

Main Article Content

Abstract

Background:


This study aims at sharing our experience with laparoscopic truncal vagotomy (TV) and gastrojejunostomy (GJ) and to highlight modifications in the form of posterior TV alone instead of anterior and posterior TV in elderly to reduce associated morbidity of prolonged gastric stasis.


Methods:


From 2017 to 2020, 16 patients underwent laparoscopic TV and GJ.  Anterior and posterior TV was performed in patients younger than 60 years and posterior only TV was performed in patients older than 60 years. Antecolic, posterior, juxta-pyloric and isoperistaltic GJ was created using stapler. During follow up, patients were classified into Visick grading. Dumping syndrome was assessed using Dumping Syndrome Rating Scale (DSRS).


Results:


Mean age of patients was 58 years. Male:female ratio was 1.7:1. There were no conversions or perioperative mortality. Two patients required laparoscopic assisted GJ. Mean operative time was 117 minutes with mean blood loss of 23.89 ml. Thirteen patients were discharged by postoperative day seven; four had delayed gastric emptying which settled with conservative management and were discharged within second week. Incidence of prolonged gastric stasis was more in patients undergoing laparoscopic anterior and posterior TV and GJ as compared to those undergoing laparoscopic posterior TV and GJ (33.33% vs 20%, p>0.05). During average follow-up period of 22 months, one patient died due to unrelated cause. Patients were classified as Visick I (n=9), II (n=6), III (n=1), and IV (n=0) at the end of last follow-up. Two patients developed dumping syndrome which was managed by dietary modifications. None developed recurrent obstruction.


Conclusion:


Laparoscopic TV and GJ is feasible and safe for GOO secondary to PUD and is associated with satisfactory perioperative and post-operative outcomes. Posterior GJ using stapler is associated with reduced complication and operative time as well as hastened learning curve. Elderly patients tolerate posterior only TV better.

Keywords

laparoscopy truncal vagotomy and gastrojejunostomy benign gastric outlet obstruction

Article Details

Author Biographies

Dr Mahesh Kumar Sethi, All India Institute of Medical Sciences, Bhubaneswar, India

Junior Resident (Academic)

Department of General Surgery

Professor Dr Manash Ranjan Sahoo, All India Institute of Medical Sciences, Bhubaneswar, India

Professor and Head

Department of General Surgery

How to Cite
Panigrahi, S., Sethi, M., & Sahoo, M. (2021). In the era of PPI, laparoscopic truncal vagotomy and gastrojejunostomy still plays an important role: A tertiary care centre experience in India. Journal of Gastric Surgery, 3(2). https://doi.org/10.36159/jgs.v3i2.84
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Paimela H, Kivilaakso E, Tuompo P, Peräkylä T, Höckerstedt K, Saarlo I. Changes in ulcer surgery following introduction of H2-blockers. Nord Med 1991;106:198-201.
  2. Schwesinger WH, Page CP, Sirinek KR, Gaskill HV 3rd, Melnick G, Strodel WE. Operations for peptic ulcer disease: paradigm lost. J Gastrointest Surg 2001;5:438-43.
  3. Csendes A, Maluenda F, Braghetto I, et al. Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Am J Surg 1993;166:45–9.
  4. Kim SM, Song J, Oh SJ, Hyung WJ, Choi SH, Noh SH. Comparison of laparoscopic truncal vagotomy with gastrojejunostomy and open surgery in peptic pyloric stenosis. Surg Endosc 2009;23:1326-30.
  5. Cherian PT, Cherian S, Singh P. Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy. Gastrointest Endosc 2007;66:491-7.
  6. Perng C, Lin H, Lo W, et al. Characteristics of patients with benign gastric outlet obstruction requiring surgery after endoscopic balloon dilation. Am J Gastroenterol 1996;91:987–990.
  7. Lau JYW, Chung SCS, Sung JJY, et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996;43:98–101.
  8. Cherian JV, Somasundaram A, Ramalingam S, Jayanthi V. Peptic ulcer disease in India--a 16-year trend analysis. Trop Gastroenterol 2010;31:260-5.
  9. Dutta AK, Chacko A, Balekuduru A, Sahu MK, Gangadharan SK. Time trends in epidemiology of peptic ulcer disease in India over two decades. Indian J Gastroenterol 2012;31:111-5.
  10. Siu WT, Tang CN, Law BKB, Chau CH, Yau KK, Yang GPE, et al. Vagotomy and Gastrojejunostomy for Benign Gastric Outlet Obstruction. Journal of Laparoendoscopic & Advanced Surgical Techniques 2004;14:266-9.
  11. Palanivelu C, Jani K, Rajan PS, Kumar KS, Madhankumar MV, Kavalakat A. Laparoscopic Management of Acid Peptic Disease. Surg Laparosc Endosc Percutan Tech 2006;16:312-6.
  12. Wyman A, Stuart RC, Enders KW, et al. Laparoscopic truncal vagotomy and gastroenterostomy for pyloric stenosis. Am J Surg 1996;171:600–3.
  13. Rangarajan M, Subramanian CS, Chandralathan TA. Laparoscopy-assisted truncal vagotomy and antecolic posterior gastro-jejunostomy for benign gastric outlet obstruction. Surg Endosc 2006;20:61–3.
  14. Abdel-Salam WN, Katri KM, Bessa SS, El-Kayal EA. Laparoscopic-Assisted Truncal Vagotomy and Gastro-Jejunostomy: Trial of Simplification. Journal of Laparoendoscopic & Advanced Surgical Techniques 2009;19:125-8.
  15. Zinner MJ, Schwarts SI, Ellis H. Complications of peptic ulcer. In: Debas HT, Mulvihill SJ (eds). Maingots Abdominal Operations, 10th ed. East Norwalk, CT: Appleton & Lange, 1997, pp. 981–997.
  16. Zuidema GD, Yeo CJ. Stomach and duodenum. In: Shackelford’s Surgery of the Alimentary Tract, 5th ed. Philadelphia: Saunders, 2002, pp. 67, 81, 127–128.