Pyloric Exclusion and Duodenal Diverticulization Injuries of the duodenum can be difficult to manage. In this chapter, exposure of the duodenum from the pylorus to the suspensory ligament of duodenum…

Truncal Vagotomy and Pyloroplasty and Highly Selective Vagotomy Vagotomy is (rarely) performed to decrease the stimulus to acid output by the parietal cells. Most peptic ulcers respond to eradication of…

Laparoscopic Gastric Resection Laparoscopically assisted gastric resection is used for benign disease or for palliation of malignancy. The laparoscopic portion may be limited to mobilization, with an extracorporeal anastomosis. Although…

Laparoscopic Gastrojejunostomy Laparoscopic gastrojejunostomy is a simple procedure that may be used when palliation of malignant upper gastrointestinal obstruction is required. It has the same drawbacks as the corresponding open…

Gastric Resection Gastric resection, or gastrectomy, is performed mainly for treatment of gastric carcinoma. Benign ulcer disease, formerly a major indication, is still sometimes treated by gastrectomy, often in emergency…

Laparoscopic Plication of Perforated Duodenal Ulcer Laparoscopic plication is an easy way to manage a simple small anterior perforation of a duodenal ulcer. Steps in Procedure Setup room as with…

Plication of Perforated Duodenal Ulcer Small anterior perforations of duodenal ulcers are treated by Graham patch plication, which may sometimes be performed laparoscopically (see Chapter 52). Larger perforations may require…

Laparoscopic Gastrostomy and Jejunostomy These procedures are useful either as incidental procedures during other laparoscopic operations (e.g., gastrostomy performed in association with laparoscopic repair of paraesophageal hernia) or when other…

Gastrostomy and Jejunostomy Gastrostomy may be performed for feeding or for decompression. The simplest open technique for creation of a gastrostomy is the Stamm procedure. Percutaneous endoscopic gastrostomy, an alternative…

Laparoscopic Esophagomyotomy Laparoscopic esophagomyotomy uses the magnification and precise dissection of minimally invasive surgery to divide the hypertrophied distal esophagus associated with esophageal achalasia. This operation has largely supplanted the…