Laparoscopic repair of perforated peptic ulcer: single-center results

Abstract

The results showed that LR for PPU is feasible with acceptable mortality and morbidity rates. Skill in laparoscopic abdominal emergencies is required. Perforations 1.5 cm or larger, posterior duodenal ulcers, and an MPI higher than 25 should be considered the main risk factors for conversion.

Role of Laparoscopy in Perforation Peritonitis

“…Morbidity and mortality in our study was 18.1% and zero % as compared to 6.2% and zero respectively in study conducted by Ahmed Khan Sangrasi et al, [9] versus 9% and 1% respectively by Navez B et al [14] Gastroduodenal Perforation Mean age of patients presenting with gastro-duodenal perforation in our study was 54.14 ± 14.4 yrs. which was slightly lower than the study conducted by Ferdinando Agresta et al [20] and was consistent with age of 59 years as in study conducted by Simone Guadagni et al [21] Laparoscopic repair was successful in 4 patients (57.1%) while in 3 patients (42.9%), laparoscopy was converted to midline laparotomy. 2 cases were converted due to gross contamination, 1 case was converted due to large size of the perforation.…”

Surgical treatment of perforated gastroduodenal peptic ulcers: comparison between open and laparoscopic approach

“…13,14 We found no suture leakage in our patients, using intraoperative endoscopy may help in reduce leaking.…”

“…18 One study suggests that laparoscopy tends to be more difficult to perform in older patients and perforations of 1.5 cm or larger and posterior duodenal ulcers were considered the main risk factors for conversion. 13 No conversions to open surgery were required in our study, however all ulcers were in the anterior surface and all perforations measured less than 1.5 cm.…”

“…13 On regard of this, laparoscopic surgery allows excellent vision and facilitates irrigation of the suprahepatic and subhepatic spaces, left subdiaphragmatic space, paracolic gutters and pelvic cavity, thus decreasing the risk of intraabdominal abscesses developing. 13,15 It is reasonable to obtain a biopsy, even with laparoscopy, but this will enlarge the hole and make closure more technically challenging. 16,17 In our technique we excised ulcer borders laparoscopically or took biopsy with intraoperative endoscopy.…”

Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper

“…Recently Guadagni et al suggests that laparoscopic repair for PPU is feasible but skill in laparoscopic abdominal emergencies are required. Perforations 1.5 cm or larger, posterior duodenal ulcers should be considered the main risk factors for conversion [61]. …”