No abstract

No abstract

Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2-6 hours from the onset of symptoms, 55 within 6-24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40-100 min for the Graham patch repair and 120-155 min for the Taylor procedure. During follow-up, 48% of patients from the "Graham patch" group and no one from the "definitive procedure" group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

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.