Laparoscopic treatment of perforated peptic ulcer

STUDY OBJECTIVE: Contribution to evaluation of the place of laparoscopic surgery in the treatment of perforated peptic ulcer. PATIENTS AND METHODS: Between January 1992 and November 1997. 17 consecutive patients underwent laparoscopic suture of a perforated peptic ulcer, with or without omentoplasty. RESULTS: Treatment was performed entirely by laparoscopy in 13 cases (76%). The median operating time was 105 min (50-220 min). The median number of doses of analgesia administered to each patient was 8 (3-20 doses). The medium hospital stay was 6 days (2-23 days). Two patients (12%) died. In 11 cases, gastroscopy was performed between 1 and 4 months after the operation, revealing healing of the ulcer in 10 cases and persistence of the ulcer in one case. None of the patients were readmitted to hospital for ulcer complications, with a median follow-up of 35 months (1-63 months). CONCLUSION: The laparoscopic treatment of perforated duodenal is a technically simple and effective procedure, intermediate between conventional surgical treatment and Taylor's method. Laparoscopic surgery may therefore have a real place in the treatment of perforated peptic ulcer.     

Therapeutic minilaparoscopy for perforated peptic ulcer

Laparoscopic repair for perforated peptic ulcer has been demonstrated to be safe and effective. We report our initial experience of applying therapeutic minilaparoscopy for peptic ulcer perforation. Five patients with perforated peptic ulcers managed by a team of surgeons using minilaparoscopy are reported. There were no conversions, perioperative morbidity, or mortality. Patients experienced minimal wound pain and required minimal parental analgesia. The access wound scars were hardly discernable at 3-month followup. Therapeutic minilaparoscopy is technically feasible for patients with perforated peptic ulcer and is associated with satisfactory clinical and cosmetic outcome.     

Acute perforated duodenal ulcer

This report is based on a personal experience with nineteen patients who were operated upon for acute perforation of a duodenal ulcer. Closure of the perforation and posterior gastroenterostomy was done in all and in twelve the appendix was removed. Drainage was used in only two cases. There was one death. This patient who was admitted in a state of shock five hours after perforation and operated upon at once died twenty-four hours later. The youngest, and only female in the group, was a girl of eighteen years. This is not a selected group but one which contains all cases of acute perforated duodenal ulcer which have come under my care in the past fifteen years.Many perforated duodenal ulcers become sealed temporarily to the undersurface of the liver, thereby preventing for a time widespread contamination of the peritoneum.Acute perforation is the result of an acute ulcerative process in either a recent or an old ulcer. The perforation is caused by erosion (acid) and not by rupture from increased pressure.The operation of choice should be closure of the perforation and posterior gastroenterostomy. The closure is made by three or four through-and-through cotton sutures re-enforced by several nearby fat tabs. Do not infold; do not use a purse-string suture.Except in the presence of advanced peritonitis, gastroenterostomy is advisable because (1) perforation does not cure the ulcer. Simple closure is followed by recurrence of ulcer in 40 to 60 per cent of the patients and in others the stomach may have motor difficulty from fixation of the pylorus to the undersurface of the liver. Gastroenterostomy is the best safeguard against recurrence and motor dysfunction of the stomach. (2) It protects the sutured area of perforation against tension and leakage. (3) It does not increase the operative risk.When the appendix is readily accessible, it should be removed. Spinal anesthesia is recommended except in the presence of shock. Drainage is rarely indicated.