Abstract
BackgroundThe literature established that, in patients without Boey's risk factors, laparoscopic repair of perforated peptic ulcers, compared to open repair, is associated to lower wound infection rate, less analgesic use, reduction in post operative pain, shorter hospital stay. Some of the main drawbacks are length of operative time and laparoscopic surgeon's experience in intracorporeal knotting.We, for first, report our preliminary experience of perforated peptic ulcers' laparoscopic repair using Medtronic U-Clip®.MethodsFrom January 2008 to June 2008 we performed laparoscopic repair of perforated peptic ulcers using Medtronic U-Clip® in 10 consecutive patients (6 men and 4 women, from 20 to 65 years-old of age). All the patients presented with iuxtapyloric perforated peptic ulcer, not greater than 10 mm, without signs of sepsis, free from major illnesses. The mini-invasive procedure was performed both by skilled and non-skilled laparoscopic surgeons under experts' surveillance. After it was recognized, perforation was sutured using U-Clip® in a full-thickness manner.Results and DiscussionWe reported no surgical complications in the peri-operative period. The clinical outcome and time needed to perform the intervention didn't change between skilled and non-skilled surgeons. The follow-up at 30 days was good.ConclusionIn our experience, the anastomotic device U-Clip® simplifies laparoscopic repair of perforated peptic ulcer, avoiding the need to perform knots and making the procedure safe and easier.
Highlights
The literature established that, in patients without Boey's risk factors, laparoscopic repair of perforated peptic ulcers, compared to open repair, is associated to lower wound infection rate, less analgesic use, reduction in post operative pain, shorter hospital stay
Lau [2] identified that the post operative pain was lower than in open repair, and there was a significant reduction in wound infection, but reoperation rate was higher than open repair
Lau's conclusion was that laparoscopic repair was safe and effective for duode
Summary
The literature established that, in patients without Boey's risk factors, laparoscopic repair of perforated peptic ulcers, compared to open repair, is associated to lower wound infection rate, less analgesic use, reduction in post operative pain, shorter hospital stay. Lau [2] identified that the post operative pain was lower than in open repair, and there was a significant reduction in wound infection, but reoperation rate was higher than open repair. Lunevicius et al [5] in a systematic review confirm good results of laparoscopic repair in low risk patients in terms of lower analgesic use, shorter hospital stay, less wound infection, but define appropriate open repair in high risk patients and report in this case a shorter operation time than laparoscopic repair
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