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Submitted
June 5, 2021
Accepted
June 14, 2021
Published
June 15, 2021
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Abstract

Background:


This study aims at sharing our experience with laparoscopic truncal vagotomy (TV) and gastrojejunostomy (GJ) and to highlight modifications in the form of posterior TV alone instead of anterior and posterior TV in elderly to reduce associated morbidity of prolonged gastric stasis.


Methods:


From 2017 to 2020, 16 patients underwent laparoscopic TV and GJ.  Anterior and posterior TV was performed in patients younger than 60 years and posterior only TV was performed in patients older than 60 years. Antecolic, posterior, juxta-pyloric and isoperistaltic GJ was created using stapler. During follow up, patients were classified into Visick grading. Dumping syndrome was assessed using Dumping Syndrome Rating Scale (DSRS).


Results:


Mean age of patients was 58 years. Male:female ratio was 1.7:1. There were no conversions or perioperative mortality. Two patients required laparoscopic assisted GJ. Mean operative time was 117 minutes with mean blood loss of 23.89 ml. Thirteen patients were discharged by postoperative day seven; four had delayed gastric emptying which settled with conservative management and were discharged within second week. Incidence of prolonged gastric stasis was more in patients undergoing laparoscopic anterior and posterior TV and GJ as compared to those undergoing laparoscopic posterior TV and GJ (33.33% vs 20%, p>0.05). During average follow-up period of 22 months, one patient died due to unrelated cause. Patients were classified as Visick I (n=9), II (n=6), III (n=1), and IV (n=0) at the end of last follow-up. Two patients developed dumping syndrome which was managed by dietary modifications. None developed recurrent obstruction.


Conclusion:


Laparoscopic TV and GJ is feasible and safe for GOO secondary to PUD and is associated with satisfactory perioperative and post-operative outcomes. Posterior GJ using stapler is associated with reduced complication and operative time as well as hastened learning curve. Elderly patients tolerate posterior only TV better.

Keywords

laparoscopy truncal vagotomy and gastrojejunostomy benign gastric outlet obstruction

Article Details

Author Biographies

Dr Mahesh Kumar Sethi, All India Institute of Medical Sciences, Bhubaneswar, India

Junior Resident (Academic)

Department of General Surgery

Professor Dr Manash Ranjan Sahoo, All India Institute of Medical Sciences, Bhubaneswar, India

Professor and Head

Department of General Surgery

How to Cite
Panigrahi, S., Sethi, M., & Sahoo, M. (2021). In the era of PPI, laparoscopic truncal vagotomy and gastrojejunostomy still plays an important role: A tertiary care centre experience in India. Journal of Gastric Surgery, 3(2). https://doi.org/10.36159/jgs.v3i2.84
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