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Abstract
Since the publication by Dragstedt and Owens, in (1943) showing the effectiveness of vagotomy in the treatment of duodenal ulcer disease, vagotomy has become the corner stone of the surgical treatment of duodenal ulcer, there has been a constant evolution in the surgical treatment, beginning with truncal vagotomy combined with a gastric drainage procedure and evolving in to highly selective vagotomy ( Dubois., 1995)
The ability of the general surgeon to perform acid reducing operations through the laparoscope has become a reality. Prior to this development, the open operations that were available to treat peptic ulcer disease had significant discomfort that discouraged patients from seeking this treatment course. In addition,the recovery period was relatively prolonged. As the field of laproscopic surgery develops, it appears that further changes will occur (Pietrafitta et al.,1998 ).
If a procedure can be done with less pain, less incision,less scar, less hospitalization,less time off work and above all less cost, and still deliver a similar outcome, it will be viewed as better (Costalat et al.,2000).
This evolution was halted in the late 1970s with the appearance of the first H2 receptor antagonist. The introduction of the H2 receptor antagonist into clinics , resulted in the majority of patients healing their ulcers with aggressive medical management (Rubin,1999).
Introduction of proton pump inhibitor (Omeprazale) and the discovery of hlelicobacter pylori have virtually eliminated the need for elective ulcer surgery, except in some patients not responding to medical treatment (George et al, 2000).
The efficacy of laparoscopic surgery in the treatment. of chronic duodenal ulcer has been demonstrated in the short and medium term by a number of authors employing different methods. Conventional techniques have been applied using minimally invasive approaches, including transthoracic truncal vagotomy, transabdominal truncal vagotomy, alone or in association with pneumatic dilatation of the pylorus, pyloromyotomy or pyloroplasty, truncal vagotomy and antrectomy, anterior and posterior supraselective vagotomy, posterior truncal vagotomy (PTV) and supraselective anterior vagotomy, PTV and anterior seromyotomy, and PTV with anterior linear gastrectomy (Dubois.,1994).
Laparoscopic vagotomy is not only beneficial to patients refractory to medical treatment, but can be used as an alternative to life-long pharmacological therapy. This has revitalized the operative treatment of peptic ulcer disease (Kathhouda&Mouiel., 2005)