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Laparoscopic Management of Perforated Ulcers

  • Mohammed Hassan Al Mahroos
  • Liane S. FeldmanEmail author
Chapter

Abstract

Perforation remains a potential lethal complication of peptic ulcer disease. The surgeon should have a high degree of suspicion for perforated ulcer when a patient presents with sudden onset of severe abdominal pain, nausea, vomiting, fever and peritonitis. This can rapidly progress to septic shock if the diagnosis and treatment are delayed. The goal of laparoscopic peptic ulcer repair is no different than that of the open repair, namely, source control through sealing of the perforation and peritoneal irrigation. This chapter describes laparoscopic repair of perforated ulcer including primary repair and Graham patch technique focusing on operating room set-up, instrumentation, operative steps, contraindications and post-operative care.

Keywords

Peptic ulcer disease Perforation Omental patch Graham patch Perforated ulcers 

Supplementary material

Video 8.1

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Key References

  1. 1.
    Muller MK, et al. Perforated peptic ulcer repair: factors predicting conversion in laparoscopy and postoperative septic complications. World J Surg. 2016;40(9):2186–93.CrossRefPubMedGoogle Scholar
  2. 2.
    Stewart B, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101(1):e9–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Soreide K, et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288–98.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc. 2010;24(6):1231–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Wang AY, Peura DA. The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world. Gastrointest Endosc Clin N Am. 2011;21(4):613–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Lau JY, et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Thorsen K, Soreide JA, Soreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg. 2014;18(7):1261–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Salama NR, Hartung ML, Muller A. Life in the human stomach: persistence strategies of the bacterial pathogen Helicobacter pylori. Nat Rev Microbiol. 2013;11(6):385–99.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Svanes C, et al. Smoking and ulcer perforation. Gut. 1997;41(2):177–80.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cid T. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2013;18(Suppl 1):12–7. doi:10.1111/hel.12076.CrossRefPubMedGoogle Scholar
  12. 12.
    Dakubo JC, Naaeder SB, Clegg-Lamptey JN. Gastro-duodenal peptic ulcer perforation. East Afr Med J. 2009;86(3):100–9.PubMedGoogle Scholar
  13. 13.
    Soreide K, Thorsen K, Soreide JA. Predicting outcomes in patients with perforated gastroduodenal ulcers: artificial neural network modelling indicates a highly complex disease. Eur J Trauma Emerg Surg. 2015;41(1):91–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Hirschowitz BI, Simmons J, Mohnen J. Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study. Clin Gastroenterol Hepatol. 2005;3(1):39–48.CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar A, et al. The etiology of pneumoperitoneum in the 21st century. J Trauma Acute Care Surg. 2012;73(3):542–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Thorsen K, et al. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011;15(8):1329–35.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ghekiere O, et al. Value of computed tomography in the diagnosis of the cause of nontraumatic gastrointestinal tract perforation. J Comput Assist Tomogr. 2007;31(2):169–76.CrossRefPubMedGoogle Scholar
  18. 18.
    Furukawa A, et al. Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging. 2005;30(5):524–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Taylor H. Perforated peptic ulcer; treated without operation. Lancet. 1946;2(6422):441–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Crofts TJ, et al. A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med. 1989;320(15):970–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev. 2013;2:CD004778.Google Scholar
  22. 22.
    Siu WT, et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235(3):313–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Byrge N, et al. Laparoscopic versus open repair of perforated gastroduodenal ulcer: a National Surgical Quality Improvement Program analysis. Am J Surg. 2013;206(6):957–62. discussion 962-3CrossRefPubMedGoogle Scholar
  24. 24.
    Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;29(10):1299–310.CrossRefPubMedGoogle Scholar
  25. 25.
    Lunevicius R, Morkevicius M. Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg. 2005;92(10):1195–207.CrossRefPubMedGoogle Scholar
  26. 26.
    Lagoo SA, Pappas TN. Laparoscopic repair for perforated peptic ulcer. Ann Surg. 2002;235(3):320–1.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lagoo S, McMahon RL, kakihara M, Pappas T, Eubanks S. The sixth decision regarding perforated duodenal ulcer. JSLS. 2002;6(4):359–68.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Pappas TN. Laparoscopic repair of perforated ulcer and Vagotomy. In: Pappas TN, Chekan EG, Eubanks S, editors. Atlas of laparoscopic surgery. Philadelphia: McGraw-Hill Professional Publishing; 1999.Google Scholar
  29. 29.
    Lunca Y. Laparoscopic repair of perforated peptic ulcer. Jurnalul de Chirurgie. 2007;3(2):1584–9341.Google Scholar
  30. 30.
    Mancini GJ, Mancini ML. Peptic ulcer surgery. In: Vernon AH, Ashley SW, editors. Atlas of minimally invasive surgical techniques. St Louis: Elsevier Saunders; 2012.Google Scholar
  31. 31.
    Walsh CJ, Khoo DE, Motson RW. Laparoscopic repair of perforated peptic ulcer. Br J Surg. 1993;80(1):127.PubMedGoogle Scholar
  32. 32.
    Michelet I, Agresta F. Perforated peptic ulcer: laparoscopic approach. Eur J Surg. 2000;166(5):405–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Nathanson LK, Easter DW, Cuschieri A. Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer. Surg Endosc. 1990;4(4):232–3.CrossRefPubMedGoogle Scholar
  34. 34.
    So JB, et al. Comparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer. Surg Endosc. 1996;10(11):1060–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Khoursheed M, et al. Laparoscopic closure of perforated duodenal ulcer. Surg Endosc. 2000;14(1):56–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Robertson GS, Wemyss-Holden SA, Maddern GJ. Laparoscopic repair of perforated peptic ulcers. The role of laparoscopy in generalised peritonitis. Ann R Coll Surg Engl. 2000;82(1):6–10.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Boshnaq TA, Martini I, Doughan S. Utilisation of the falciform ligament pedicle flap as an alternative approach for the repair of a perforated gastric ulcer. BMJ Case Rep. 2016;10 doi:10.1136/bcr-2015-213025.
  38. 38.
    Munro WS, Bajwa F, Menzies D. Laparoscopic repair of perforated duodenal ulcers with a falciform ligament patch. Ann R Coll Surg Engl. 1996;78(4):390–1.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Costalat G, Alquier Y. Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH). Surg Endosc. 1995;9(6):677–9. discussion 680.CrossRefPubMedGoogle Scholar
  40. 40.
    Lunevicius R, Morkevicius M. Comparison of laparoscopic versus open repair for perforated duodenal ulcers. Surg Endosc. 2005;19(12):1565–71.CrossRefPubMedGoogle Scholar
  41. 41.
    Halkic N, Pescatore P, Gillet M. Laparoscopic-endoscopic management of perforated pyloroduodenal ulcer. Endoscopy. 1999;31(9):S64–5.PubMedGoogle Scholar
  42. 42.
    Matsuda M, et al. Laparoscopic omental patch repair for perforated peptic ulcer. Ann Surg. 1995;221(3):236–40.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Seelig MH, et al. Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers. J Clin Gastroenterol. 2003;37(3):226–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Pai D, et al. Role of abdominal drains in perforated duodenal ulcer patients: a prospective controlled study. Aust N Z J Surg. 1999;69(3):210–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Lee FY, et al. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg. 2001;136(1):90–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Thompson AR, et al. Laparoscopic plication of perforated ulcer: results of a selective approach. South Med J. 1995;88(2):185–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Moller MH, et al. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol. 2010;45(7–8):785–805.CrossRefPubMedGoogle Scholar
  48. 48.
    Urbano D, et al. Alternative laparoscopic management of perforated peptic ulcers. Surg Endosc. 1994;8(10):1208–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Abd Ellatif ME, et al. Laparoscopic repair of perforated peptic ulcer: patch versus simple closure. Int J Surg. 2013;11(9):948–51.CrossRefPubMedGoogle Scholar
  50. 50.
    Wong CS, et al. Eradication of Helicobacter pylori for prevention of ulcer recurrence after simple closure of perforated peptic ulcer: a meta-analysis of randomized controlled trials. J Surg Res. 2013;182(2):219–26.CrossRefPubMedGoogle Scholar
  51. 51.
    Yuan Y, et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev. 2013;12:CD008337.Google Scholar
  52. 52.
    Kumar P, Khan HM, Hasanrabba S. Treatment of perforated giant gastric ulcer in an emergency setting. World J Gastrointest Surg. 2014;6(1):5–8.CrossRefPubMedPubMedCentralGoogle Scholar

Suggested Reading

  1. Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc. 2010;24:1231–9.CrossRefPubMedGoogle Scholar
  2. Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;29:1299–310. doi:10.1007/s00268-005-7705-4.CrossRefPubMedGoogle Scholar
  3. Muller M, Wrann S, Widmer J, Klasen J, Weber M, Hahnloser D. Perforated peptic ulcer repair: factors predicting conversion in laparoscopy and postoperative septic complications. World J Surg. 2016;40(9):2186–93.CrossRefPubMedGoogle Scholar
  4. Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev. 2013;2:CD004778.Google Scholar
  5. Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, Søreide JA. Perforated peptic ulcer. Lancet. 2015;386:1288–98.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Mohammed Hassan Al Mahroos
    • 1
  • Liane S. Feldman
    • 2
    Email author
  1. 1.Department of SurgeryMcGill University Health CentreMontrealCanada
  2. 2.Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Division of General SurgeryMcGill University Health CentreMontrealCanada

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