Abstract
The advent of more effective and tolerable drugs (H2 antagonists, proton pump inhibitors, antibiotics for Helicobacter pylori, HP, infection) in the treatment of the peptic ulcer has brought about a radical change in the surgical approach to ulcer disease. In fact we can observe an increasing election for minor surgery and a progressive increase in the treatment in emergency for perforating complications. This figure is likely to be attributed on the one hand to the number of surgical indications and on the other to the increasingly widespread use of nonsteroid anti-inflammatory drugs (NSAIDs), especially in the elderly, where surgery has progressively increased in recent years. The peptic ulcer remains the most common cause of gastroduodenal perforation with an incidence ranging from 2% to 10% of the patients with a peptic ulcer [1] and, consequently, the treatment of a perforated peptic ulcer (PPU) remains today the most frequent indication for gastric emergency surgery [2]. The progress of medical treatment, and in particular the radical treatment of HP, has gradually decreased the use of major gastric surgery. Resective treatment (so-called acid-reduction treatment) has decreased as have recurrences of ulcerative disease, and consequently the need for re operation. Considering these conditions the mini-invasive technique, as in other fields, has been adopted to treat a perforated peptic ulcer.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lui FY, Davis KA (2010) Gastroduodenal perforation: maximal or minimal intervention? Scand J Surg 99:73–77
Lagoo S, McMahon RL, Kalkharu M et al (2002) The sixth decision regarding perforated duodenal ulcer. JSLS 6:359–368
Mouret J, Francois Y, Vignal J et al (1990) Laparoscopic treatment of perforated duodenal ulcer. Br J Surg 77:1006
Nathanson LK, Easter DW, Cuschieri A (1990) Laparoscopic repair peritoneal toilette of perforated duodenal ulcer. Surg Endosc 4:232–233
Sanabria AE, Morales CH, Villegas MI (2005) Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev 4:CD004778
Sanabria AE, Morales CH, Villegas MI (2005) Laparoscopic repair for perforated peptic ulcer disease. The Cochrane Library 4[Last assessed as up-to-date: March 9 2010] DOI: 10.1002/14651858.CD004778.pub2
Lau H (2004) Laparoscopic repair of perforated peptic ulcer. A meta-analysis. Surg Endosc 18:1013–1021
Lunevicius R, Morkevicius M (2005) Systemic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg 92:1195–1207
Bertleff M, Halm JA, Bemelman WA et al (2009) Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA trial. World J Surg 33:1368–1373
Siu WT, Leong HT, Law BKB et al (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235:313–319
Lau WY, Leung KL, Kwong KH et al (1996) A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224:131–138
Lunevicius R, Morkevicius M (2005) Management strategies, early results, benefits and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg 29:1299–1310
Bertleff M, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24:1231–1239
Kakhry S, Watts D, Daley B et al (2001) Current diagnostic approach lack sensitivity in the diagnosis of perforating blunt small bowel injury (SBI): findings from a large multi-institutional trial. J Trauma 51:1232
Schein M (2010) Perforated peptic ulcer. In: Schein M, Rogers PN, Assalia A (eds) Schein’s common sense emergency abdominal surgery, Springer, Berlin Heidelberg, pp 157–166
Miller RE, Nelson SW (1971) The roentgenologic demonstration of tiny amounts of free intarperitoneal gas: experimental and clinical studies. AJR Am J Roentgenol 112:574–585
Chen SC, Wang HP, Chen WJ (2002) Selective use of ultrasonography for the detection of pneumoperitoneum. Acad Emerg Med 9:643–645
Phatak Mg, Frank SJ, Ellis JJ (1984) Computed tomography of bowel perforation. Gastrointest Radiol 9:133–135
Cho KC, Baker SR (1994) Extraluminal air: diagnosis and significance. Radiol Clin North Am 32:829–844
Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film. J Comput Assist Tomogr 16:713–716
Earls JP, Dachaman AH, Colon E et al (1993) Prevalence and duration of postoperative pneumoperitoneum: sensitivity of CT vs left lateral decubits radiography. AJR 161:781–785
Chen CH, Huang HS, Yang CC, Yeh YH (2001) Features of perforated peptic ulcers in conventional computed tomography. Hepatogastroenterology 48:1393–1396
Fultz PJ, Skucas J, Weiss SL (1992) CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease. Gastrointest Radiol 17:5–8
Hainaux B, Agneessen E, Bertinotti R et al (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR 187:1179–1183
Imuta M, Awai K, Nakayama Y et al (2004) Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgical confirmed 155 patients. Imaging 28:334–339
Rice RP, Thompson WM, Gedgaudas RK (1982) The diagnosis and significance of extraluminal gas in the abdomen. Radiol Clin North Am 20:819–837
Cho HS, Yoon SE, Park SH et al (2009) Distinction between upper and lower gastrointestinal perforation. Usefulness of the periportal free air sign on computed tomography. Eur J Radiol 69:108–113
Ghekiere O, Lesnik A, Hoa D et al (2007) Value of computed tomography in the diagnosis of the cause of non traumatic gastrointestinal tract perforation. J Comput Assist Tomogr 31:169–176
Maniatis V, Chryssikopoulos H, Roussakis A et al (2000) Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 25:373–379
Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357:2277–2284
Moriwaki Y, Sugiyama M, Toyoda H (2009) Ultrasonography for the diagnosis of the intraperitoneal free air on chest-abdominal-pelvic blunt trauma and critical acute abdominal pain. Arch Surg 144:137–141
Singh JP, Steward MJ, Booth TG et al (2010) Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 92:182–188
Agresta F, Mazzarolo G, Ciardo LF, Bedin N (2005) The laparoscopic approach in abdominal emergiencies: has the attitude changed? A single-center review of a 15 year experience. Surg Endosc 22:1255–1262
Bhogal R, Athwal R, Durkin D et al (2008) Comparison between open and laparoscopic repair of perforated peptic ulcer disease. Worl J Surg 32:2371–2374
Ates M, Coban S, Sevil S, Terzi A (2008) The efficacy of laparoscopic surgery in patients with peritonitis. Surg Laparosc Endosc Percutan Tech 18:453–456
Boey J, Wong J (1987) Perforated duodenal ulcers. World J Surg 11:319–324
Lunevicius R, Morkevicius M (2005) Comparison of laparoscopic versus open repair for perforated duodenal ulcers. Surg Endosc 19:1565–1571
Katkhouda N, Mavor E, Mason RJ et al (1999) Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134:845–850
Robertson GS, Wemyss-Holden SA, Maddern GJ (2000) Laparoscopic repair of perforated duodenal ulcers. The role of laparoscopy in generalized peritonitis. Ann R Coll Surg Engl 82:6–10
Vaidya BB, Garg CP, Shah JP (2009) Laparoscopic repair of perforated peptic ulcer with delayed presentation. J Laparosc Adv Surg Tech 19:153–156
Lee FY, Leung KL, Lai BS et al (2001) Predicting mortality and morbility of patients operated on for perforated peptic ulcers. Arch Surg 136:90–94
Walsh CJ, Khoo DE, Motson RW (1993) Laparoscopic repair of perforated peptic ulcer. Br J Surg 80:127
Wemyss-Holden S, White SA, Robertson G, Lloyd D (2002) Color coding of sutures in laparoscopic perforated duodenal ulcer: a new concept. Surg Laparosc Endosc Percutan Tech 12:177–179
Matsuda M, Nishiyama M, Hanai T et al (1995) Laparoscopic omental patch repair for perforated peptic ulcer. Ann Surg 221:236–240
Guglielminotti P, Bini R, Fontana D, Leli R (2009) Laparoscopic repair for perforated peptic ulcers with U-CLIP. World J Emerg Surg 4:28
Darzi A, Chesire NJ, Somers SS (1993) Laparoscopic omental patch repair with an automated stapler. Br J Surg 80:1552
Costalat G, Alquier Y (1995) Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcers using the ligamentum teres hepatis. Surg Endosc 9:677–679
Tate JJT, Dawson JW, Lau WY et al (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80:235
Tate JJT, Dawson JW, Lau WY et al (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80:235
Bertleff M, Stegmann T, Liem R et al (2009) Comparison of closure of gastric perforation ulcers with biodegradable lactide-glycolide-caprolactone or omental patches. JSLS 13:550–554
Druart ML, Van Hee R, Etienne J et al (1997) Laparoscopic repair of perforated duodenal ulcer. A prospective multicenter clinical trial. Surg Endosc 11:1017–1020
Siu WT, Chau CH, Law BKB et al (2004) Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg 91:481–484
Cellan-Jones CJ (1929) A rapid method of treatment in perforated duodenal ulcer. BMJ 1:1076–1077.
Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery. A systematic review and meta-analyses. Ann Surg 240:1074–1085
Naegaard JM, Edwin B, Reiertsen O et al (1999) Laparoscopic and open operation in patients with perforated peptic ulcer. Eur J Surg 165:209–214
Adachi Y, Mori M, Maehara Y et al (1997) Surgical results of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroenterol 92:516–548
Roviello F, Rossi S, Marrelli D et al (2006) Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol 4:19
Miserez M, Eypasch E, Spangenberger W et al (1996) Laparoscopic and conventional closure of perforated peptic ulcer: a comparison. Surg Endosc 10:831–836
Pappas TN, Lagoo SA (2002) Laparoscopic repair for perforated peptic ulcer. Ann Surg 235:320–321
Aird I (1935) Perforation of carcinoma of the stomach into the general peritoneal cavity. Br J Surg 22:545–554
Lee HJ, Park DJ, Yang HK et al (2006) Outcome after emergency surgery in gastric cancer patients with free perforation or severe bleeding. Dig Surg 23:217–223
Lehnert T, Buhl K, Dueck M et al (2000) Two-staged radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol 26:780–784
Kitakado Y, Tanigawa N, Muraoka R (1997) A case report perforated early gastric cancer. Nippon Geka Hokan 66:86–90
Kasakura Y, Ajai JA, Mochizuki F et al (2002) Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer. J Surg Oncol 7:219–224
So JB, Yam A, Cheah WK et al (2000) Risk factors related to operative mortality and morbility in patients undergoing emergency gastrectomy. Br J Surg 87:1702–1707
Gertsch P, Yip SK, Chow LW, Launder IJ (1995) Free perforation of gastric carcinoma. Arch Surg 130: 177–181
Taylor H (1957) The non-surgical treatment of perforated peptic ulcer. Gastroenterology 33:353–368
Croft TJ, Kenneth GM, Park MB (1989) A randomized trial of non operative treatment for perforated duodenal ulcer. N Engl J Med 320:970–973
Marshall C, Ramanswamy P, Bergin FG et al (1999) Evaluation of a protocol for the nonoperative management of perforated peptic ulcer. Br J Surg 86:131–134
Bucher P, Oulbaci W, Morel P et al (2007) Results of conservative treatment for perforated gastroduodenal ulcer in patients not eligible for surgical repair. Swiss Med WKLY 137:337–340
Notashi AY, Salimi J, Rahimian H et al (2005) Evaluation of Mannheim Peritonitis Index and multiple failure score in patients with peritonitis. Ind J Gastroenterol 24:197–200
Suggested Readings
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P (2006) Laparoscopy for abdominal emergencies. Evidencebased guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29
Agresta F, Ansaloni L, Baiocchi L, Bergamini C, Campanile FB, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Scaramuzza G, Del Favero AL (2011) Consensus Development Conference of the Società Italiana Chirurgia Endoscopica e nuove tecnologie (SICE); Associazione Chirurghi Ospedalieri Italiani (ACOI); Società Italiana di Chirurgia (SIC); Società Italiana Chirurgia d’Urgenza e Trauma (SICUT), Società Italiana Chirurghi dell’Ospedalità Privata (SICOP) and the European Association for Endoscopic Surgery (EAES). In press
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Italia
About this chapter
Cite this chapter
Mirabella, A., Lupo, M., Di Marco, F., Mandalà, V. (2012). Gastroduodenal Ulcer. In: Mandalà, V. (eds) The Role of Laparoscopy in Emergency Abdominal Surgery. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2327-7_2
Download citation
DOI: https://doi.org/10.1007/978-88-470-2327-7_2
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2326-0
Online ISBN: 978-88-470-2327-7
eBook Packages: MedicineMedicine (R0)