Anterior lesser curvature laser seromyotomy with posterior truncal vagotomy: a potential treatment of peptic ulcer disease.

Anterior lesser curvature seromyotomy combined with posterior truncal vagotomy has been suggested as an alternative to proximal gastric vagotomy in the treatment of peptic ulcer. The argon laser may be an ideal instrument for performing seromyotomy. This study compares anterior lesser curvature argon laser seromyotomy/posterior or truncal vagotomy with anterior proximal gastric vagotomy/posterior truncal vagotomy in a canine preparation. Six dogs underwent anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy and six others underwent anterior proximal gastric vagotomy/posterior truncal vagotomy. Gastric emptying and acid secretion studies were performed preoperatively and at 1 and 6 months postoperatively. Operating time and blood loss were determined. Anterior lesser curvature argon laser seromyotomy was performed with the argon laser at 10 W, continuous, delivered through a 600 micron unsheathed quartz fibre. Anterior proximal gastric vagotomy and posterior truncal vagotomy were performed in the standard fashion. Solid phase gastric emptying was slowed with both operations (P less than 0.05) but this was not manifest clinically. Blood loss (millilitres) was less following anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy than following anterior proximal gastric vagotomy/posterior truncal vagotomy (21(6.8) versus 95(28.1), mean (s.e.m.), P less than 0.05) but operating time was not significantly different between the groups. Mean basal acid secretion was reduced by 64 per cent 6 months after anterior lesser, curvature argon laser seromyotomy/posterior truncal vagotomy (P less than 0.05) and by 53 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). Mean stimulated acid secretion was reduced by 41 per cent 6 months after anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy (P less than 0.05) and by 24 per cent after anterior proximal gastric vagotomy/posterior truncal vagotomy (not significant). We conclude that anterior lesser curvature argon laser seromyotomy/posterior truncal vagotomy is an acceptable alternative to anterior proximal gastric vagotomy/posterior truncal vagotomy and may provide superior parietal cell denervation with less operative blood loss.