G. Costalat et Y. Alquier, COMBINED LAPAROSCOPIC AND ENDOSCOPIC TREATMENT OF PERFORATED GASTRODUODENAL ULCER USING THE LIGAMENTUM-TERES-HEPATIS (LTH), Surgical endoscopy, 9(6), 1995, pp. 677-680
We propose a novel technique for laparoscopic treatment of perforated
gastroduodenal ulcers. The principle of this procedure involves the cl
osure of the perforated ulcer using the ligamentum teres hepatis (LTH)
. The LTH is cut near its hepatic insertion. The umbilical extremity o
f LTH is grasped with a Dormia noose passed through the ulcerated perf
oration via a gastroscope. Using the noose, the LTH is pulled through
the ulcerated perforation until its volume fits and completely closes
the perforation. This laparoscopic technique was performed in 15 patie
nts (12 M, 3 F) with anterior perforated duodenal ulcer revealed withi
n the previous 6 h. The procedure could not be performed in three case
s: diameter of the perforation exceeding 1.5 cm (n = 1), general purul
ent peritonitis (n = 2). In the other 12 cases, closure of the ulcerat
ed perforation with the LTH was realized without technical difficulty.
The postoperative course was uncomplicated. The posttreatment comfort
was excellent; the mean period of hospitalization was 10 days (range,
8-14 days). An endoscopic examination carried out following 5 weeks o
f anti-H-2 treatment showed that cicatrization of the ulcer was good a
nd that no pyloric stenosis remained. These initial results suggest th
at laparoscopic treatment of perforated gastroduodenal ulcer using the
LTH is a simple procedure which can be performed with general assuran
ce of success in patients whose perforated ulcers have occurred quite
recently. As the laparoscopic procedure is less aggressive than a lapa
rotomy, it enhances the postoperative comfort of patients and prevents
the risk of parietal complications. Compared to laparoscopic endosutu
re this procedure is simple, effective, easier, and particularly adapt
ed to large ulcerated perforation or when an ulcer's edges are tough o
r friable, tending to tear when knots are tied.