Laparoscopic Repair of Peptic Ulcer Perforation Without Omental Patch Versus Conventional Open Repair

Abstract

Laparoscopic surgery, when optimized by a simple repair without an omental patch and 10 mm of a large-channel aspirator-irrigator, may be safely and effectively applied to the patients with small duodenal perforated peptic ulcers (<10 mm) and because of its having low risk factors. The procedure may be an alternative treatment to other procedures when in experienced hands.

Laparoscopic Repair of Perforated Duodenal Ulcer

“…This operation does not require re-moval of tissue, as is the case with splenectomy and colon resection that necessitates minilaparotomy. Recently pub-lished papers generally recommend laparoscopic repair of perforated peptic duodenal ulcer as a safe and effective method for selected patients, although they are cautious because of relatively small number of cases 7 . Even when published studies were pooled in meta-analysis, the out-come concerning possible advantages of laparoscopic approach to perforated duodenal ulcer was not clear 8,13 .…”

“…A year later, Nathanson et al described the suture repair of perforated peptic ulcer 5 . Since then many efforts have been made to compare laparoscopic and open repair, respectively [6][7][8][9][10][11][12] . However, recent papers suggest that laparoscopic repair is safe and effective pro-cedure in selected patients, offering shorter operating time, less postoperative pain and shorter postoperative hospital stay 6,12 .…”

The simple suture laparoscopic repair of peptic ulcer perforation without an omental patch

“…If patients are at low risk for leakage, we perform laparoscopic simple suture repair of the peptic ulcer perforation without an omental patch. For three patients who had adhesions caused by chronic cholecystitis, technical difficulty because of inappropriate ulcer localization, or diabetes mellitus with a high MPI and a 12-mm perforation, the laparoscopic surgery was converted to conventional open surgery [2,3]. Although Seelig et al [4] did not use any selection criteria for laparoscopic repair without an omental patch, they observed one leak in the 21 patients in their study.…”

“…A review of literature'' by Bertleff and Lange [1]. In the article, the authors state: ''Ates et al [2] presented results with simple suture repair of peptic ulcer perforation without using pedicled omentoplasty; this significantly shortened operating time but the question remains of whether it is safe to abandon omentoplasty completely.'' This point must be clarified.…”

“…We absolutely agree with the authors that avoiding omentoplasty might shorten the operating time, but it might be the reason for the higher incidence of leakage at the repaired ulcer side. We prefer laparoscopic simple suture repair of peptic ulcer perforation, without an omental patch, based on criteria that include the duration of abdominal pain, mean Mannheim Peritoneal Index (MPI), Acute Physiology and Chronic Health Evolution II score, and size of the perforation [2,3]. If patients are at low risk for leakage, we perform laparoscopic simple suture repair of the peptic ulcer perforation without an omental patch.…”