Laparoscopic closure of perforated duodenal ulcer

Background: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. H owever, the incidence of perforated duodenal ulcer and its associated morta lity have not been reduced by modern methods of therapy. Laparoscopic simpl e closure and omental plug by suturing, fibrin glue, and stapler have been successful. Methods: Over a 1-year period (1996-97), 21 patients with perforated duoden al ulcer were operated on in our hospital by laparoscopic simple closure an d omental patch. The mean age was 36.4 +/- 11.8 years (range, 18-61). Twent y patients were male (93.7%), The moan duration of pain was 9.1 +/- 11.7 hs (range, 2-48). Three patients had a previous history of duodenal ulcer (14 .3%), and another three (14.3%) patients had a history of nonsteroidal anti inflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 pat ients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had fra nk pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%). Results: The mean operative time was 71.6 +/- 24.6 mins (range, 40-120), an d the mean hospital stay was 5.2 +/- 1.6 days (range, 3-9). The mean time t o resume oral fluids was 3.1 +/- 0.8 days (range, 2-4). Only one patient wa s reoperated due to leakage identified by gastrographin swallow. Conclusions: This procedure is safe and efficient; however, further study o f its long-term effectiveness and comparability to existing therapy is stil l needed.