Skip to main content

Part of the book series: Updates in Surgery ((UPDATESSURG))

  • 1165 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lui FY, Davis KA (2010) Gastroduodenal perforation: maximal or minimal intervention? Scand J Surg 99:73–77

    PubMed  CAS  Google Scholar 

  2. Lagoo S, McMahon RL, Kalkharu M et al (2002) The sixth decision regarding perforated duodenal ulcer. JSLS 6:359–368

    PubMed  Google Scholar 

  3. Mouret J, Francois Y, Vignal J et al (1990) Laparoscopic treatment of perforated duodenal ulcer. Br J Surg 77:1006

    Article  PubMed  CAS  Google Scholar 

  4. Nathanson LK, Easter DW, Cuschieri A (1990) Laparoscopic repair peritoneal toilette of perforated duodenal ulcer. Surg Endosc 4:232–233

    Article  PubMed  CAS  Google Scholar 

  5. Sanabria AE, Morales CH, Villegas MI (2005) Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev 4:CD004778

    PubMed  Google Scholar 

  6. 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

    Google Scholar 

  7. Lau H (2004) Laparoscopic repair of perforated peptic ulcer. A meta-analysis. Surg Endosc 18:1013–1021

    PubMed  CAS  Google Scholar 

  8. Lunevicius R, Morkevicius M (2005) Systemic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg 92:1195–1207

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Siu WT, Leong HT, Law BKB et al (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235:313–319

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Bertleff M, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24:1231–1239

    Article  PubMed  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Chapter  Google Scholar 

  16. 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

    CAS  Google Scholar 

  17. Chen SC, Wang HP, Chen WJ (2002) Selective use of ultrasonography for the detection of pneumoperitoneum. Acad Emerg Med 9:643–645

    Article  PubMed  Google Scholar 

  18. Phatak Mg, Frank SJ, Ellis JJ (1984) Computed tomography of bowel perforation. Gastrointest Radiol 9:133–135

    Article  PubMed  CAS  Google Scholar 

  19. Cho KC, Baker SR (1994) Extraluminal air: diagnosis and significance. Radiol Clin North Am 32:829–844

    PubMed  CAS  Google Scholar 

  20. Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film. J Comput Assist Tomogr 16:713–716

    Article  PubMed  CAS  Google Scholar 

  21. 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

    PubMed  CAS  Google Scholar 

  22. Chen CH, Huang HS, Yang CC, Yeh YH (2001) Features of perforated peptic ulcers in conventional computed tomography. Hepatogastroenterology 48:1393–1396

    PubMed  CAS  Google Scholar 

  23. Fultz PJ, Skucas J, Weiss SL (1992) CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease. Gastrointest Radiol 17:5–8

    Article  PubMed  CAS  Google Scholar 

  24. Hainaux B, Agneessen E, Bertinotti R et al (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR 187:1179–1183

    Article  PubMed  Google Scholar 

  25. 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

    Google Scholar 

  26. Rice RP, Thompson WM, Gedgaudas RK (1982) The diagnosis and significance of extraluminal gas in the abdomen. Radiol Clin North Am 20:819–837

    PubMed  CAS  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. Maniatis V, Chryssikopoulos H, Roussakis A et al (2000) Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 25:373–379

    Article  PubMed  CAS  Google Scholar 

  30. Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  31. 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

    Article  PubMed  Google Scholar 

  32. Singh JP, Steward MJ, Booth TG et al (2010) Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 92:182–188

    Article  PubMed  CAS  Google Scholar 

  33. 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

    Article  Google Scholar 

  34. 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

    Article  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. Boey J, Wong J (1987) Perforated duodenal ulcers. World J Surg 11:319–324

    Article  PubMed  CAS  Google Scholar 

  37. Lunevicius R, Morkevicius M (2005) Comparison of laparoscopic versus open repair for perforated duodenal ulcers. Surg Endosc 19:1565–1571

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. 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

    PubMed  CAS  Google Scholar 

  40. Vaidya BB, Garg CP, Shah JP (2009) Laparoscopic repair of perforated peptic ulcer with delayed presentation. J Laparosc Adv Surg Tech 19:153–156

    Article  Google Scholar 

  41. 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

    Article  PubMed  CAS  Google Scholar 

  42. Walsh CJ, Khoo DE, Motson RW (1993) Laparoscopic repair of perforated peptic ulcer. Br J Surg 80:127

    PubMed  CAS  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. Matsuda M, Nishiyama M, Hanai T et al (1995) Laparoscopic omental patch repair for perforated peptic ulcer. Ann Surg 221:236–240

    Article  PubMed  CAS  Google Scholar 

  45. Guglielminotti P, Bini R, Fontana D, Leli R (2009) Laparoscopic repair for perforated peptic ulcers with U-CLIP. World J Emerg Surg 4:28

    Article  PubMed  Google Scholar 

  46. Darzi A, Chesire NJ, Somers SS (1993) Laparoscopic omental patch repair with an automated stapler. Br J Surg 80:1552

    Article  PubMed  CAS  Google Scholar 

  47. Costalat G, Alquier Y (1995) Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcers using the ligamentum teres hepatis. Surg Endosc 9:677–679

    Article  PubMed  CAS  Google Scholar 

  48. Tate JJT, Dawson JW, Lau WY et al (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80:235

    Article  PubMed  CAS  Google Scholar 

  49. Tate JJT, Dawson JW, Lau WY et al (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80:235

    Article  PubMed  CAS  Google Scholar 

  50. 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

    Article  PubMed  Google Scholar 

  51. 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

    Article  PubMed  CAS  Google Scholar 

  52. Siu WT, Chau CH, Law BKB et al (2004) Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg 91:481–484

    Article  PubMed  CAS  Google Scholar 

  53. Cellan-Jones CJ (1929) A rapid method of treatment in perforated duodenal ulcer. BMJ 1:1076–1077.

    Article  PubMed  CAS  Google Scholar 

  54. 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

    Article  PubMed  Google Scholar 

  55. 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

    Article  Google Scholar 

  56. 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

    PubMed  CAS  Google Scholar 

  57. 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

    Article  PubMed  Google Scholar 

  58. Miserez M, Eypasch E, Spangenberger W et al (1996) Laparoscopic and conventional closure of perforated peptic ulcer: a comparison. Surg Endosc 10:831–836

    Article  PubMed  CAS  Google Scholar 

  59. Pappas TN, Lagoo SA (2002) Laparoscopic repair for perforated peptic ulcer. Ann Surg 235:320–321

    Article  PubMed  Google Scholar 

  60. Aird I (1935) Perforation of carcinoma of the stomach into the general peritoneal cavity. Br J Surg 22:545–554

    Article  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

  62. Lehnert T, Buhl K, Dueck M et al (2000) Two-staged radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol 26:780–784

    Article  PubMed  CAS  Google Scholar 

  63. Kitakado Y, Tanigawa N, Muraoka R (1997) A case report perforated early gastric cancer. Nippon Geka Hokan 66:86–90

    PubMed  CAS  Google Scholar 

  64. 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

    Google Scholar 

  65. 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

    Article  PubMed  CAS  Google Scholar 

  66. Gertsch P, Yip SK, Chow LW, Launder IJ (1995) Free perforation of gastric carcinoma. Arch Surg 130: 177–181

    Article  PubMed  CAS  Google Scholar 

  67. Taylor H (1957) The non-surgical treatment of perforated peptic ulcer. Gastroenterology 33:353–368

    PubMed  CAS  Google Scholar 

  68. 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

    Article  Google Scholar 

  69. 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

    Article  PubMed  CAS  Google Scholar 

  70. 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

    PubMed  CAS  Google Scholar 

  71. 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

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • 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

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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)

Publish with us

Policies and ethics