ALTERNATIVE LAPAROSCOPIC MANAGEMENT OF PERFORATED PEPTIC-ULCERS

Surgery-namely, suture closure-is still the treatment of choice for pe rforated peptic ulcers, despite the proven efficacy of Taylor's conser vative approach. Such conservative management, however, has been prove n less effective in high-risk patients and those with perforations mor e than 12 h old. Here we suggest alternative laparoscopic treatments f or perforated peptic ulcers. We have treated laparoscopically six pati ents (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H-2-blockers, antibiotics, and fluids were administe red in the p.o. course; the follow-ups range from 6 to 18 months. On t he basis of our experience, the treatment of choice for perforated pep tic ulcers is Taylor's conservative procedure and laparoscopic drainag e of the abdominal cavity when there is mild peritoneal reaction (usua lly less than 6 h from the onset of perforation). In case of remarkabl e peritonitis (usually more than 12 h), it is mandatory to add an accu rate lavage. When the site of perforation is concealed by the peritone al inflammation it should not be searched; when visible, it might be o bliterated with the round ligament or an omental tissue strand, partic ularly if larger than 1 cm in diameter.