LAPAROSCOPIC PLICATION OF PERFORATED ULCER - RESULTS OF A SELECTIVE APPROACH

We reviewed our experience with laparoscopy for perforated ulcer from April 1, 1992, to March 31, 1993. Ah patients admitted to the gastroin testinal surgery service with a diagnosis of perforated viscus had eva luation for possible laparoscopic Graham plication (LGP). Of eight pat ients considered, five had successful diagnostic laparoscopy. Two pati ents with anterior duodenal ulcers had LGP. Operative times were 85 an d 106 minutes; postoperative stays were 5 and 8 days. Three procedures were converted to formal laparotomy when laparoscopy revealed gastric or prepyloric ulcers. Three patients had immediate laparotomy because of known disease process. Two additional patients were treated with o pen plication by other surgeons; their operative times were 98 and 110 minutes and postoperative stays, 6 and 4 days. Hospital charges avera ged $6,573 for the two laparoscopic plications, $7,511 for the four pl ications not done laparoscopically, and $20,995 for the two cases conv erted to open plication. A selective approach allowed two Graham patch closures to be done laparoscopically without complications, at a cost comparable to that of open surgery.