LAPAROSCOPIC UNDERRUNNING OF BLEEDING DUODENAL ULCERATION - A MINIMALIST APPROACH TO THERAPY

Surgical management of bleeding duodenal ulcer has traditionally inclu ded a procedure to reduce gastric acid production to enable ulcer heal ing and reduce the likelihood of rebleeding. The availability of intra venous proton pump inhibitors in the peri-operative period may promote rapid ulcer healing and as a component of anti-Helicobacter eradicati on therapy greatly reduces the incidence of ulcer recurrence. Using th is approach, six patients with actively bleeding duodenal ulcer underw ent laparoscopic duodenotomy and attempted suturing of the bleeding si te. One patient required conversion to open surgery and subsequently r e-bled at 60 h, necessitating a partial (Billroth II) gastrectomy. In the remaining five patients suture control of bleeding and luminal clo sure were completed laparoscopically without complications. Laparoscop ic repair of acutely bleeding duodenal ulcers is technically feasible and had a low complication rate in this small series.