INTRODUCTION
Peptic ulcer affects about 5% of the global population. About 70-90% of patients with gastric ulcer and 80-95% with duodenal ulcers are infected with
H. pylori.After the era of proton-pump inhibitor, management of peptic ulcer disease has changed dramaticallyand manifested by early satiety and fullness after meals and repeated vomiting. endoscopic balloon dilatation of pylorus followed by long term H2-receptor antagonists was suggested that surgery could be avoided in up to 80% of the patients,with longer follow up.Over50% will require ulcer surgery within two years of dilatation. In addition, the dilatation carries a risk of perforation rate up to 10%. Balloon dilatation is only reserved for those patients who are too high a risk surgery.


AIM OF THE WORK
This study is designed to assess the role of laparoscopic truncal vagotomy and laparoscopic gastro-jujenostomy in the treatment of patient with gastric outlet obstruction due to cicatrized duodenal ulcer.

Subjects and methods
After approval of local ethics committee, all patients included in the study will be informed about the procedure and will sign an informed written consent before carrying the procedure
This study will be concerned on 15 patients, in the upper gastrointestinal surgery unit, Alexandria main University Hospital presenting with gastric outletobstruction due to cicatrized duodenal ulcer confirmed by upper GI endoscope and C.T gastrography