Development of laparoscopic anterior seromyotomy and right posterior truncal vagotomy for ulcer prophylaxis.

This study investigated the feasibility of a laparoscopic antiulcer procedure. The following antiulcer operations were performed laparoscopically in 20 pigs: truncal vagotomy and pyloroplasty (n = 5), highly selective vagotomy (n = 5), right truncal vagotomy and left highly selective vagotomy (n = 5), and anterior seromyotomy and posterior truncal vagotomy (n = 5). Each procedure was videotaped and assessed in terms of ease of access, need for additional trocars, requirements for suturing, and complexity of the procedure. The anterior seromyotomy and posterior truncal vagotomy provided the optimal combination of antiulcer prophylaxis and adaptivity to the laparoscopic approach. We employed a Nd:YAG laser operating at 20 W delivered via a 600 micron sculpted tip which simplified the anterior seromyotomy. Anterior seromyotomy-posterior truncal vagotomy was then performed in three cadavers without evidence of perforation of the stomach. Our initial experience in a 46-year-old male demonstrates that the procedure can be performed with relative ease in humans. Thus, an effective antiulcer operation, anterior seromyotomy-posterior truncal vagotomy can be performed laparoscopically and may be a reasonable alternative for treating those patients who had a poor response to medical therapy.