Laparoscopic Taylor procedure in Chinese patients

Abstract

Laparoscopic t r e a t m e n t of condit ions prev ious ly approached wi th open techniques has been used in a va r i e ty of surgical d iseases including chronic duodenal ulcers. 1 Pa r i e t a l cell vago t om y as a n open procedure, h a s genera l ly b e e n accepted as the op t ima l ope ra t ion for the elective t r e a t m e n t of chronic uncompl icated duodenal ulcers, bu t the exper ience wi th its laparoscopic va r i a t ion h a s r e m a i n e d l i m i t e d ) In 1978 Hill and B a r k e r 2 descr ibed the pos ter ior t runca l vago tomy along wi th h ighly selective an te r io r vagotomy. Pa r i e t a l cell vago tom y achieves a complete denervat ion of the ac id-secre t ing gas t r ic m u c o s a while prese rv ing the funct ion of the an t ropylor ic pump. The opera t ion descr ibed by Hill and B a r k e r was des igned to reduce the t ime requ i red for comple te dene rva t ion of the lesser curve of the s t om ach and to overcome va r i a t ions prev ious ly observed in the longte rm resul ts of pa r i e t a l cell vagotomies . I n a f u r t h e r a t t e m p t to s impl i fy th is technique, Tay lo r and coworkers 3 descr ibed in 1982 a n opera t ion whe reby the an te r io r h ighly select ive vago t om y of the procedure by Hill and B a r k e r 2 was rep laced by an ante r ior lesser curve se romyotomy. The exper ience wi th this opera t ion has shown t h a t the resu l t s a re as good as those ob ta ined wi th pa r i e ta l cell vagotomies . 4-6 Therefore , i t seems app rop r i a t e for laparoscopic surgeons to adop t the Taylor procedure , because it is technical ly eas ie r to pe r fo rm t h a n a fo rmal pa r ie ta l cell vagotomy. This laparoscopic technique has been used by iso la ted t eams . 1 We repor t our exper ience in a ser ies of 15 Chinese pa t i en t s undergo ing su rge ry for chronic duodenal ulcers over a 2-year period. The ana tomic charac te r i s t ics of the e sophagea l h i a t u s in our pa t i en t s have led us to modify the laparoscopic technique descr ibed by o the r groups. 7