Repair Of Perforated Duodenal Ulcer Research Articles

Outcome of Laparoscopic Repair of Duodenal Ulcer Perforation Compared with Open Technique

Background: The surgical treatment of perforated duodenal ulcers is not controversial; however, the best surgical strategy is still up for debate. The perforation closure with an omental patch or without it during surgery is the basis of perforated duodenal ulcers treatment. Laparoscopic surgery can now be used to repair a perforated duodenal ulcer due to developments in minimal access surgery. Aim: In this analysis, the results of open versus laparoscopic repair of perforated duodenal ulcers were compared in terms of operating time, length of hospital stays, postoperative pain and complications after the operation, among other factors. Methods: This prospective comparative study was held at the surgical department of Agha Khan University Hospital, Karachi for one-year duration from January 2022 to December 2022. Patients were divided randomly into two groups, A and B, who underwent operations using laparoscopic and conventional methods, correspondingly, and results were compared. Results: This study found that men between the ages of 51 and 60 were most frequently affected. Laparoscopic group patients experienced much less post-operative pain, need less analgesics, minimum wound infection, and less stay in hospital than open group patients (p 0.05). Conclusions: Laparoscopic repair when performed on carefully chosen patients for perforated duodenal ulcers, it is safe, practical, and produces better outcomes than open surgery. Keywords: Omental patch, laparoscopic repair, open repair, perforated duodenal ulcer

Laparoscopic repair of perforated duodenal ulcer: a comparison with the open surgical technique

Laparoscopic repair of perforated duodenal ulcer: a comparison with the open surgical technique

Primary percutaneous coronary intervention without stenting using excimer laser and manual thrombectomy in STEMI with duodenal ulcer perforation: a case report.

BackgroundST-segment elevation myocardial infarction (STEMI) and peptic ulcer perforation are both medical emergencies that require urgent intervention. In case that these time-sensitive medical emergencies present concomitantly, it remains unclear which one should be treated first.Case summaryAn 85-year-old man with melaena, epigastric pain, and severe anaemia was transferred to our emergency department and diagnosed as having inferior STEMI based on electrocardiogram. Emergency coronary angiography (CAG) revealed severe stenosis with thrombus in the proximal right coronary artery. Immediate oesophagogastroduodenoscopy and abdominal computed tomography detected the presence of duodenal ulcer perforation. Primary percutaneous coronary intervention (PCI) without stenting using excimer laser coronary angioplasty and manual thrombectomy was performed under intravascular ultrasound (IVUS) guidance to avoid dual antiplatelet therapy (DAPT). After successful PCI, the perforated viscus was surgically repaired with a laparoscopic omental patch. On Day 7, endoscopic haemostasis treated the oozing of blood from the duodenal ulcer. On Day 21, follow-up CAG and IVUS showed residual stenosis with organized thrombus in the culprit lesion, in which a drug-coated stent was directly implanted. He was discharged with a favourable clinical course on Day 23.DiscussionWe judged that PCI should take precedence over the surgical repair of perforated duodenal ulcer in our case since STEMI was an immediate life-threatening compared to the perforated viscus which had no active exsanguination. Excimer laser coronary angioplasty with manual thrombectomy might be an adequate option to avoid stent deployment and subsequent DAPT in such complex scenarios.

Laparoscopy: A Better Approach for Perforated Duodenal Ulcer.

BackgroundLaparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair.MethodsIn this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation.ResultsThe mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications.ConclusionsLaparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.

S2873 Abdominal Abscess Formation After Repair of Perforated Duodenal Ulcer

INTRODUCTION: Peptic ulcer disease is the most common cause of gastrointestinal perforations, with duodenal ulcers causing 2 to 3 times more perforations than gastric ulcers. The most common causes of peptic ulcer perforation are H. pylori infection and chronic NSAID use. Abdominal abscess, a known complication of subclinical perforated ulcers, is often detected prior to or at the time of diagnosis. We present a case of abdominal abscess formation as a complication after repair of perforated duodenal ulcer. CASE DESCRIPTION/METHODS: A 72-year-old male with history of CAD presented with severe, sudden onset, epigastric pain with nausea and vomiting after ingesting a pill. On admission, vitals were normal. Labs were significant for WBC 15,700 with normal lactic acid and lipase. CT abdomen/pelvis was concerning for perforation. He underwent emergent ex-lap with repair of a perforated post-pyloric duodenal ulcer with drain placement. 4 days later, he endorsed worsening abdominal pain and was found to have two large communicating abdominal abscesses (perihepatic, anterior abdominal) on CT [figures A and B]. Contrast extravasation was seen from the duodenal ulcer to the anterior abdominal abscess [figure A]. A drain was placed into the perihepatic abscess with fluid culture growing Candida albicans. After drain removal, repeat CT revealed resolving perihepatic abscess but enlarging anterior abdominal abscess [figure C], suggesting spontaneous closure between the two, for which an additional drain was placed. He completed a course of Cefepime, Metronidazole and Fluconazole and was started on quadruple therapy for H. pylori. After 4 days of bowel rest, he was successfully started on a diet after upper GI series revealed no contrast extravasation. DISCUSSION: Peptic ulcer perforation should be suspected in patients with sudden onset, severe, diffuse abdominal pain. Emergent surgery is indicated once perforation is identified on imaging. All patients with perforated ulcers should receive aggressive acid suppressive therapy with high dose PPI and evaluation of H. pylori. Empiric treatment for H. pylori remains controversial for perforated ulcers. However, if confirmed, its eradication significantly reduces ulcer recurrence and complications such as reperforation. Our case demonstrates the importance of continued monitoring for abdominal abscesses after surgical repair. Worsening pain may indicate abscess formation, which warrants further imaging and management, such as drainage, stent placement, and/or antibiotics.Figure 1.: Contrast extravasation noted from duodenal ulcer to anterior abdominal abscess.Figure 2.: 19 × 12 × 18 cm Perihepatic abscess (axial and coronal views).Figure 3.: Interval increase in anterior abdominal abscess from 6 × 13 × 18 cm to 8 × 13 × 18 cm (axial and sagittal views).

Open versus laparoscopic repair of perforated duodenal ulcer: a comparative study

Background: Surgery is the mainstay of the treatment for perforated duodenal ulcer by closing the perforation with or without omental patch. There are no controversies in the surgical treatment of perforated duodenal ulcer but the best approach to surgery is still debatable. Advances in minimal access surgery has made it possible to close the perforated duodenal ulcer laparoscopically. The present study was conducted to compare the results of open and laparoscopic repair of perforated duodenal ulcer in terms of operative time, postoperative pain, hospital stay, and post-operative complications etc.Methods: The study was conducted in Dr. V. M. Government Medical College and Hospital located in Solapur (Maharashtra) from December 2008 to December 2010. It was a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Most commonly affected age in this study was 51 to 60 years with male preponderance. Post-operative pain, analgesic requirement, wound infection, hospital stay, was significantly less in laparoscopic group as compared to open group (p<0.05).Conclusions: Laparoscopic repair of perforated duodenal ulcer is safe and feasible in properly selected patients and has superior results as compared to open surgery.

COMPARATIVE STUDY OF LAPAROSCOPIC AND OPEN REPAIR OF DUODENAL ULCER PERFORATION

Background: Duodenal ulcer perforation is one of the common complications of duodenal ulcer disease despite the use of various anti-ulcer agents and eradication therapy. Laparoscopy has become increasingly popular in management of duodenal ulcer perforation. Aim of the Work: to compare between the efficacy and safety of laparoscopic and laparotomy repair of perforated duodenal ulcer in terms of operative time, postoperative pain, postoperative complication, Hospital stay and resuming normal activity. Patient and Methods, This prospective study included 50 patients with perforated duodenal peptic ulcer were admitted to the General Surgery Department in Ain Shams University Hospitals and AhmedMaher Teaching Hospital from May 2016 to December 2017. The patients were divided by random serial number method into two groups: group A included 25 patients for laparoscopic procedure, and group B included 25 patients for open repair. Results: laparoscopic repair of perforated peptic ulcers is superior to the open repair as regards the postoperative pain, return of bowel habit, start of oral diet and length of hospitalization. Currently, the main drawbacks of laparoscopic repair are a longer operation and a higher incidence of intra-abdominal collection. The open repair has a higherrate of chest infection, wound infection. Suture leakage was reported in one case in the open group and in one case in laparoscopic group. Conclusion: laparoscopic repair of perforated peptic ulcers is a safe emergency procedure with many advantages such as less postoperative pain, early return of bowel habit, early start of oral diet, less length of hospitalization, good cosmetic outcome and less postoperative complications as(wound infections ,chest infections andincisional hernias).

Laparoscopic and open repair for perforated duodenal ulcer: single-center experience.

IntroductionPerforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery.AimTo analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer.Material and methodsThe study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group.ResultsIn 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3–14), in the open group 11.7 days (range: 6–63), and in the conversion group 9.3 days (8–10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014–2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010–2013).ConclusionsThe laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20–25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.

Comparison study between the outcome of laparoscopic and open repair of perforated duodenal ulcer

Background Duodenal ulcer perforation is a surgical emergency that may lead to a risk for major morbidity and even mortality. Patient selection criteria are crucial to guide the surgeon in selecting the option of laparoscopic approach for patients with perforated duodenal ulcers. The purpose of this study was to compare the resulting outcomes for laparoscopic and open approaches for the repair of perforated duodenal ulcers. Patients and methods A total of 26 patients with perforated duodenal ulcers were included in this study, operated at Alain Hospital and Ain Shams University Hospitals, from June 2013 to June 2016. A total of 13 patients were operated by the laparoscopic approach and 13 patients were operated by the open approach. Follow-up indices such as mean operative time, hospitalization expense, and postoperative pain were included. The main outcomes were immediate surgical postoperative complications, fatalities, and reoperation. Secondary outcomes included operative time, postoperative pain, postoperative hospital stay, and time to resume diet. Results There were no major differences in the selected patients between these two procedures in main outcomes including overall surgical efficacy including surgical complication rate and surgery-related deaths. Further analysis of the surgical outcome revealed that laparoscopic repair had less surgical wound complication rate (wound infections and incisional hernias) compared with the open approach. Otherwise both approaches had almost similar rates of leakage, intra-abdominal collections, and ileus and thromboembolic complications. Regarding the secondary outcomes, it was notable that postoperative pain was much less, return to the regular diet was earlier, and hospital stay was decreased in the laparoscopic approach. This remarkable improvement of the secondary outcome attributed to overall patient satisfaction in the laparoscopic approach. Conclusions Laparoscopic approach is comparable with the open approach as a modality of repair for perforated peptic ulcer in the properly selected patients. The obvious advantages of laparoscopic surgery are the lower surgical site infection rates, early return to regular diet, shorter hospital stay, early return to work, less postoperative pain, better cosmetic outcome, and improved overall patient satisfaction. However, more studies should be undertaken to further assess the safety and efficacy of laparoscopic repair for peptic ulcer disease in the high risk patients’ category.

Laparoscopic omental patch repair for perforated peptic ulcer: an early experience from Al-Sahel Teaching Hospital

Background Peptic ulceration is a common condition. The most common etiologic factors are drugs use like NSAIDs and infection by Helicobacter pylori. The perforated duodenal ulceration is not an uncommon surgical emergency, ur aim was to show our experience with Laparoscopic omental patch repair for perforated peptic ulcer. Patient and Method In this study, we included 16 patients who underwent laparoscopic repair of perforated duodenal ulcer at our department. The patients were urgently admitted to the emergency department. Result In our study, we have neither morbidity nor mortality. The recorded time for the operation was 72–90 min, and the median hospital stay was 6 days. Our study confirms the safety of laparoscopic approach in the treatment of perforated peptic duodenal ulcer. Conclusion Laparoscopic omental patch repair for perforated peptic ulcer is safe and practical.

MID-TERM OUTCOME OF PERFORATED DUODENAL ULCER REPAIR USING SINGLE-PORT LAPAROSCOPIC SURGERY

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate mid-term outcome of perforated duodenal ulcer repair using SPLS. Methods: A prospective study on 72 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue University Hospital and Hue Central Hospital from January 2012 to Mars 2016. Results: The mean age was 48.8 ± 14.0 (17 - 79) years. Male/female ratio was 17.0. Four patients (5.6%) with history of abdominal surgery were successfully treated by pure SPLS. Patients were classified as ASA 1, ASA 2 and ASA 3 in 86.1%, 12.5%, and 1.4% of cases, respectively. Using Boey scoring system, there were 86.1% and 12.5% of cases classified as Boey 0 and Boey 1 while there were no Boey 2 and 3 cases. The average size of perforation was 4.1 ± 2.6 (1.5-22) mm. The perforation was situated on the anterior duodenal wall in 98.6% of cases and on the posterior duodenal wall in 1.4% of cases. There was one case (1.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (1.4%) in which the perforation was situated on the posterior duodenal wall. Average length of hospital stay was 5.7 ± 1.2 (4-12) days. Post-operative complications rate was 2.8%. There was no leakage from the repair site, no port-site hernia and no post-operative mortality. At 2-month follow-up visit, patients were classified as Visick 1 in 95.1% of cases and Visick 2 in 4.9% of cases and the duodenal ulcer was completely healed on gastroduodenoscopy in 86.7% of cases. At 12-month follow-up, patients were classified as Visick 1 in 93.5% of cases and Visick 2 in 4.3% of cases. There was one case (2.2%)diagnosed with recurrent duodenal ulcer perforation at 5 months after the repair of the first perforation. On gastroduodenoscopy, recurrent duodenal ulcer was seen in 8.9% of cases. Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Conversion rate was 1.4%. Recurrent duodenal ulcer rate was 8,9% and recurrent duodenal ulcer perforation rate was 2.2% after 12-month follow-up. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

Laparoscopic versus open repair of perforated duodenal peptic ulcer: a randomized controlled trial

Objective The aim of this study was to compare between laparoscopic and laparotomy repair of perforated duodenal ulcer in terms of operative time, postoperative pain, postoperative complication, hospital stay, and resuming normal activity. Background Laparoscopic surgery has become a standard of care in many of the elective procedures; however, it is still gaining popularity in conditions associated with peritonitis, such as perforated duodenal ulcer. Materials and methods This is a prospective study that included 50 patients with perforated duodenal peptic ulcer admitted to the General Surgery Department in Menoufia University Hospitals from October 2012 to April 2014. The patients were divided by random serial number method into two groups: group A consisted of 25 patients for laparoscopic procedure, and group B consisted of 25 patients for open repair. Results In group A, 21 patients underwent successful laparoscopic surgery, and four patients were converted to laparotomy, and in group B, 24 patients were evaluable, and one patient died on the fourth postoperative day not related to surgical cause. Operating time was significantly longer in the laparoscopy group, 145 ± 8.4 versus 110 ± 13 min. Patients who underwent laparoscopic repair were associated with lower morbidity, with P-value less than 0.05. No significant difference was found regarding leak or intra-abdominal abscess. Hospital stay was significantly shorter in the laparoscopic group, 6.9 ± 2.2 versus 8.9 ± 3.3 days. Patients who underwent laparoscopic procedure resumed normal activity earlier than the patients in the laparotomy group, 14 ± 1.9 versus 20.5 ± 3.9 days, with P-value less than 0.001. Conclusion Laparoscopic correction of perforated peptic ulcer causes less postoperative pain, postoperative complications, and hospital stay.

Laparoscopic Repair of Perforated Duodenal Ulcer (Series of 50 Cases)

Background: Perforated peptic ulcer is a common surgical emergency. The classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overall utility. The aim of this study is to assess the efficacy of laparoscopic repair of perforated duodenal ulcer. Patients and Methods: This study included 50 patients presented by perforated peptic ulcer between July 2009 and August 2014. They were submitted to laparoscopic omental patch repair with thorough peritoneal wash. Patients’ demographics, diagnostic techniques, management and outcome were evaluated. Results: The mean age was 38.6 years with male to female ratio being 1.6:1. The perforation was diagnosed by plain X-ray abdomen in erect position in 43 patients and by abdominal CT scan in 7 patients. The laparoscopic repair of the perforation was successful in 48 patients while in 2 patients mid-line laparotomy was needed for proper control of the severe intra-abdominal sepsis. Post-operatively, all patients tolerated soft diet on the 3rd post-operative day and full diet on the 4th post-operative day. The mean duration of hospital stay was 4.5 days. Two patients developed post-operative intra-abdominal collection that was treated by ultrasound guided drainage, three patients developed umbilical port site wound infection while only two patients developed leakage, one of them reoperated after failed conservative surgery. No mortality was encountered in the study. Conclusion: Laparoscopic repair of perforated peptic ulcer is a safe and reliable technique with accepted morbidity and mortality rates with all the advantages of the minimally invasive surgery.

RESULTS OF THE SUTURE OF THE PERFORATION BY SINGLE-PORT LAPAROSCOPIC SURGERY (SPLS) FOR THE PERFORATED DUODENAL ULCER TREATEMENT

Background Single-port laparoscopic surgery (SPLS) was increasingly used on several surgical diseases. The aim of this study is evaluation of the results of the suture of the perforation by SPLS for the perforated duodenal ulcer treatement. Methods From January 2012 to July 2014, 35 patients with perforated duodenal ulcers underwent simple suture of the perforations by SPLS at Hue University Hospital and Hue Central Hospital. Results The mean age was 45.9 ± 14.4 years. The sex ratio (male/female) was 16.5 and the mean of BMI was 19.2 ± 2.3. There was one patient (2.9%) with previous history of laparoscopic repair of perforated duodenal ulcer. The duration of the symptoms was 9.9 ± 12.3 hours. 97.1% of patients had the perforations of the anterior wall of the duodenum. The mean size of the perforation was 4.7 ± 3.4 mm (2 – 22mm). 2.9% of patients had the perforations of the posterior wall of the duodenum. The rate of the conversion to the open surgery was 2.9%. The mean operative time was 75.8 ± 33.7min, and the mean hospital stay was 5.8 ± 1.4 days. The mean of the analgesic requirement time was 2.9 ± 0.8 days. The wound length was 1.9 ± 0.1 cm. There was 5.9% of the patients had wound infection. There was no operation-related mortality. Conclusions Simple suture of the perforation by single-port laparoscopic surgery is a feasible and safe procedure, and it may be a scarless surgical technique for perforated duodenal ulcers treatement. Key words: single-port laparoscopic surgery, perforated duodenal ulcer

Roscoe Reid Graham (1890 to 1948): A Canadian Pioneer in General Surgery

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers-often referred to as the "Graham patch"-he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient's symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy away from. He also spent a large portion of his career dedicated to the study of rectal prolapse, working tirelessly to rid his patients of this awful affliction. He was recognized by a number of different surgical associations for his operative successes and was awarded membership to those both in Canada and the United States. Despite all of these accolades, Dr. Graham remained grounded and always fervent in his dedication to the patient and their presenting symptom(s), reminding us that to do anything more would be "meddlesome." In an age when medical professionals are often all too eager to make unnecessary interventions, it is imperative that we look back at our predecessors such as Roscoe Reid Graham, for they will continually redirect us toward our one and only obligation: the patient.

Outcome of laparoscopic repair of perforated duodenal ulcers

Laparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy. This was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score. Of the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort. LSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Laparoscopic Repair of a Large Duodenal Perforation Secondary to an Indwelling Nasogastric Tube in a Tracheotomized Adult

Laparoscopic repair of perforated duodenal ulcers is safe and effective in centers with experience and increasingly performed by laparoscopic surgeons. However, the role of laparoscopy for the management of large duodenal perforations (>1 cm) is unclear. To date, no experience has been reported with emergency laparoscopic repair of large perforations for gastroduodenal ulcers. The commonest reason for conversion to open surgery is a perforation size of more than 1 cm. This paper reports a case of a large duodenal perforation due to a nasogastric tube in a 26-year-old male who had undergone a tracheostomy, following a cut-throat injury. This large perforation was successfully diagnosed and repaired laparoscopically. This is probably the first paper in the English literature to report duodenal perforation due to a nasogastric tube in an adult and also the first report of a successful laparoscopic repair of a large duodenal perforation.

Minilaparotomy for Perforated Duodenal Ulcer

The usefulness of the minilaparotomy approach for perforated duodenal ulcer repair was retrospectively evaluated in 37 patients (26 men; mean age, 56.5 years). Simple closure with an omental patch by minilaparotomy (skin incision, < or = 7 cm) was successful in 86.5% of the cases, with an operative mortality of 2.7%. Compared with the results in historic control patients who underwent conventional open surgery (n = 27), a shorter operative time (P < 0.01), lower frequency of analgesic use (P = 0.03), earlier passage of flatus (P < 0.01), and shorter hospital stay (P = 0.04) were obtained in the patients undergoing minilapartomoy. The postoperative morbidity was identical between the two groups (16.2% versus 33.3%, P = 0.40). On multivariate analysis, a large amount of intraabdominal fluid was the only significant risk factor for extension of the minilaparotomy wound (P = 0.012). The minilaparotomy approach appears to be a feasible, safe, and less invasive approach compared with the conventional open approach and could be a useful alternative to the laparoscopic approach in selected patients with perforated duodenal ulcer.

Laparoscopic management of perforated peptic ulcer with single suture or single suture and modified taylor procedure

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.