New surgical strategy for gastroduodenal ulcer: laparoscopic approach.

Although peptic gastroduodenal ulcers are rarely treated surgically today, when surgery is required a laparoscopic approach is possible with its well known advantages. The most widely used technique is vagotomy by various modalities. Training in laparoscopy requires good instrumentation to avoid complications. Vagotomy can be truncal and bilateral via laparoscopy or thoracoscopy, which is the easiest and quickest procedure; moreover, the sequelae are less important and less frequent, as has been reported. It can also be highly selective or mixed, such as the Taylor procedure; and large series have been reported with good results. Gastric resection is rarely used for peptic ulcers, although it is feasible laparoscopically; it requires a large experience. Long-term results of laparoscopic vagotomy are now available and have indicated the same results as are attained with open surgery.