With an increased incidence of APD, more and more patients are taking long-term PPIs. However, there is recent evidence that long-term PPIs can cause renal damage, more so in diabetics. Can surgeons offer laparoscopic highly selective vagotomy as an alternative to long-term medications? Surgery may offer permanent relief to most of these patients - especially the poorly (medically) compliant ones.
we were one of the first to start open HSV and it"s modification Taylor"s proceedure in India.By the time laproscopic era came the incidence of ulcer disease was treated with H2 rec antagonists and then ppis.Eventhough we have done both proceedures laparoscopically with good results,but now surgery for uncomplicated DU has become outdated and patients are well aware of it.Even for GERD surgery in this part of the Globe is slowly waning away.For a nonulcer disease with APD symptoms to offer HSV presently, are we justified?Probably the cycle will turn towards HSV with increased evidence of complications due tothe use of PPIs in future.Presently I would say NO for only acid peptic symptoms.
Thanks for your input sir.
I actually meant can we offer surgery only in a select group of patients where PPIs are required everyday for many years. If patient stops taking drugs, symptoms recur, some patients have symptoms severe enough to interfere with their work & family life, etc. In young, fit patients with no comorbids, can we offer?
What about adverse effects & cost of long-term PPIs?
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