Alternative laparoscopic management of perforated peptic ulcers
- 35 Downloads
Surgery—namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers.
We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31–81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6–15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months.
On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.
Key wordsLaparoscopic surgery Sutureless laparoscopic treatment Perforated duodenal ulcer
Unable to display preview. Download preview PDF.
- 1.Ball ABS, Thomas PA, Evans SJ (1989) Operative mortality after perforated peptic ulcer. Br J Surg 76: 521–522Google Scholar
- 2.Bardhan KD, Cust G, Hincliffe RFC, Williamson FM, Lyon C, Bose K (1988) Changing pattern of admissions and operations for duodenal ulcer. Br J Surg 76: 230–236Google Scholar
- 3.Bornman PC, Theodorou NA, Jeffery PC, Marks IN, Essel HP, Wright JP, Terblanche J (1990) Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg 77: 73–75Google Scholar
- 4.Berne TV, Donovan AJ (1989) Nonoperative treatment of perforated duodenal ulcer. Arch Surg 124: 830–832Google Scholar
- 5.Ceneviva R, de Castro e Silva O Jr, Castelfranchi PL, Módena JLP, Santos RF (1986) Simple suture with or without proximal gastric vagotomy for perforated duodenal ulcer. Br J Surg 73: 427–430Google Scholar
- 6.Christensen A, Bousfield R, Christiansen J (1988) Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2-receptor antagonists. Ann Surg 207(1): 4–6Google Scholar
- 7.Costalat G, Dravet F (1991) Traitement des perforations d'ulcère gastro-duodénal sous coelioscopie avec utilisation du ligament rond. J Chir 128(2): 91–93Google Scholar
- 8.Crofts TJ, Park KGM, Steele RJC, Chung SSC, Li AKC (1989) A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 320: 970–973Google Scholar
- 9.George RL, Smith IF (1991) Long-term results after omental patch repair in patients with perforated duodenal ulcers: a 5- to 10-year follow-up study. Can J Surg 34(5): 447–449Google Scholar
- 10.Keane TE, Dillon B, Afdhal NH, McCormack CJ (1988) Conservative management of perforated duodenal ulcer. Br J Surg 75: 583–584Google Scholar
- 11.Kristensen ES (1980) Conservative treatment of perforated peptic ulcer. Acta Chir Scand 146: 189–193Google Scholar
- 12.Mouret P, François Y, Vignal J, Barth X, Lombard-Platet R (1990) Laparoscopic treatment of perforated peptic ulcer. Br J Surg 77: 1006Google Scholar
- 13.Perrotin J, Simon PH (1975) Interèt de la mèthode de Taylor dans le traitement des ulcères perforés gastroduodénaux. Ann Chir 29: 143–149Google Scholar
- 14.Raimes SA, Devlin HB (1987) Perforated duodenal ulcer. Br J Surg 74: 81–82Google Scholar
- 15.Tate JJT, Dawson JW (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80: 235Google Scholar
- 16.Taylor H (1946) Perforated peptic ulcer treated without operation. Lancet, ii: 441–444Google Scholar
- 17.Taylor H (1957) The non-surgical treatment of perforated peptic ulcer. Gastroenterology 33(3): 353–368Google Scholar
- 18.Werbin N, Kashtan H, Wasserman I, Wiznitzer T (1990) Perforated duodenal ulcer in the elderly patient. Can J Surg 33(2): 143–144Google Scholar
- 19.Conservative management of perforated peptic ulcer [Editorial] (1989). Lancet, ii: 1429–1430Google Scholar