Background-Aim: Peptic ulcer perforation represents a major cause of mortality and morbidity. Requiring emergency attention and surgical management, it traditionally involved open repair -laparotomy. In 1989, Mouret et al. applied the first laparoscopic sutureless fibrin glue omental patch for perforated duodenal ulcer repair. The aim of this study is to show that laparoscopic management of a perforated ulcer produces very good results and is a less invasive technique compared with open repair. Patients and Methods: This study included 56 patients treated in two clinics in Athens, Greece from 1996 to 2008, of whom 41 were men and 15 were women with ages ranging from 23 to 86 years. Of these patients, 39 were operated within 2 -6 hours of perforation, 15 within 6 -24 hours and 2 within 24 hours. In 36 cases, perforation was located in the duodenum while in 20, it was identified in the prepyloric region. Results: Simple suture of the site of perforation was performed in 48 patients. The laparoscopic modified Taylor procedure was decided for 8 patients with a history of chronic duodenal ulcer and extended pharmacologic therapy, all of whom were operated on within 6 hours from the onset of clinical signs and symptoms. Conversion to open repair was required in one patient. The operating time was 40-100 min for simple suture and 120-155 min for the Taylor procedure. Conclusions: Laparoscopic repair of a perforated peptic ulcer is a relatively safe and simple method, when performed by an experienced laparoscopic surgeon. Where indicated, the laparoscopic modified Taylor procedure offers a valid alternative to the permanent medical therapy of a gastroduodenal ulcer.

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We describe the case of a 68-year old woman who presented with an acute onset of epigastric pain, nausea and vomiting that had begun 12 hours earlier. Acute pancreatitis was diagnosed based on the elevated value of serum amylase. Triglycerides, calcium, liver enzymes and bilirubin values were within normal limits. The patient denied having consumed alcohol. An abdominal ultrasonography showed gallstones and sludge in the gall bladder. As part of the preoperative evaluation, the patient underwent MRCP. The following anomalies were diagnosed: pancreas divisum, drainage of the cystic duct into the right hepatic duct near the hepatic hilum and drainage of the right median segmental hepatic duct into the left hepatic duct. The patient was referred to a tertiary hospital for further evaluation and treatment where she underwent laparoscopic cholecystectomy. The postoperative course was uneventful and the patient was discharged three days later. During the 4-month follow-up period the patient remained asymptomatic.