COMBINED LAPAROSCOPIC-ENDOSCOPIC METHOD USING AN OMENTAL PLUG FOR THERAPY OF GASTRODUODENAL ULCER PERFORATION

Background: Laparoscopic techniques have been proposed as an alternati ve to open surgery for therapy of peptic ulcer perforation. They provi de better postoperative comfort and absence of parietal complications, but leakage occurs in 5% of cases. We describe a new method combining laparoscopy and endoluminal endoscopy, designed to ensure complete cl osure of the perforation. Methods: Six patients with anterior ulcer pe rforations (4 duodenal, 2 gastric) underwent a concomitant laparoscopy and endoluminal endoscopy with closure of the orifice by an omental p lug attracted into the digestive tract. Results: All perforations were sealed. The mean operating time was 72 minutes. The mean hospital sta y was 5.5 days. There was no morbidity and no mortality. At the 30-day evaluation all ulcers but one (due to Helicobacter pylori persistence ) were healed. Conclusions: This method is safe and effective. Its adv antages compared with open surgery or laparoscopic patching as well as its cost-effectiveness should be studied in prospective randomized tr ials.