Laparoscopic repair for perforated peptic ulcer.

Abstract

Great strides in the medical management of peptic ulcer disease have resulted in a radical change in the indications for surgical intervention. Elective surgery for peptic ulcer disease has markedly declined, although there has been no decrease in the incidence of perforation secondary to peptic ulcer disease. Perforation of a peptic ulcer is the development of a complication in acute or chronic preexisting peptic ulcer diathesis. In the past, surgical management of a perforated peptic ulcer included treatment of the local complication; i.e., omental patch closure of the perforated ulcer, 1 as well as definitive management of the disease process. Pharmacological advances, with highly effective H2 antagonists and proton pump inhibitors, have made it possible to successfully inhibit acid production, obviating the need for acid-reducing surgery. Also, with the discovery of H. pylori, the pathogenesis of peptic ulcer disease has become more clearly defined. Of even greater significance, the ease of diagnosis, treatment, and eradication of H.Pylori infection have resulted in a marked decline in ulcer recurrence.