The laparoscopic approach to modified Taylor's procedure in the treatment of chronic duodenal ulcer: an improved technique.

Laparoscopic modified Taylor's procedure for chronic duodenal ulcer was performed in three patients. A new, specially developed combination instrument allowed the operation to be performed easily, sometimes using only four introduction sites. Coagulation, suction, and rinsing can be performed at the same time, and the hook knife, scissors, or different forceps can be introduced through the operating channel of the instrument. An overcast seam to approximate the seromyotomy was done using the technique developed for transanal endoscopic microsurgery. Instead of the silver clips, specially handmade steel and titanium clips were used to fix the PDS suture. No major postoperative complications occurred. The gastric acid output under basal condition and stimulation showed a decrease ranging from 47% to 79%. Endoscopic examination performed on the 4th postoperative week showed complete recovery in all cases.