Laparoscopic Truncal Vagotomy, Antrectomy and Billroth II Reconstruction for Chronic Non-Healing Peptic Ulcer Disease: A Case Series and Review of Literature

Aaron M Hurd, MD MS, Mariah Alexander, MD, Matt Mancini, MD, Gregory Mancini, MD. University of Tennessee Graduate School of Medicine

Background: Despite advances in medical and endoscopic management of peptic ulcer disease, chronic non-healing peptic ulcer disease remains the most common indication for well-described anti-ulcer surgical procedures. The severity of ulcer disease refractory to medical and lifestyle changes mandates an aggressive surgical approach to achieve acid suppression, resection of concerning gastric pathology and reconstruction to minimize the afferent limb and avoid potential complications. We describe laparoscopic treatment of chronic non-healing peptic ulcer disease.

Methods: Case series and review of the literature

Results: Five patients carefully selected for intractable non-healing chronic peptic ulcer disease and gastric outlet obstruction were treated laparoscopically over a 3-year period. Four patients underwent vagotomy and antrectomy with gastrojejunostomy, whereas one simply required vagotomy and pyloroplasty. As expected, laparoscopic treatment was well tolerated, with immediate amelioration of pain and obstructive symptoms in addition to quick recovery and gradual resumption of regular diet by 6 weeks.

Conclusions: Although medical and endoscopic treatment of peptic ulcer disease has certainly diminished the frequency and volume of anti-ulcer surgical procedures, laparoscopic truncal vagotomy and antrectomy with Billroth II reconstruction is effective and leads to excellent functional results with symptom resolution in chronic non-healing peptic ulcer disease. In carefully selected patients, aggressive laparoscopic treatment is a viable option limiting recurrent disease.