Perforated duodenal peptic ulcer. Laparoscopic treatment of perforation and peptic ulcer disease.

Study aim: The aim of this retrospective study was to report a continuous s eries of 44 perforated duodenal peptic ulcers operated on through laparosco pic approach with curative treatment of the peptic ulcer disease for socioe conomic purpose. Patients and method: From February 1995 to May 1996, 44 patients were opera ted on laparoscopically. There werre 42 men and two women (mean age: 36 yea rs). All patients had peritonitis with pneumoperitoneum in 68%. Duodenal pe ptic ulcer was known in 12 patients and antecedent of episodic epigastric p ain were present in 27, Four trocads were used. The diagnosis was confirmed by abdominal exploration and peritoneal lavage was performed with physiolo gical serum. Results: The procedures were: suture of perforated ulcer associated with po sterior vagotomy and anterior seromyotomy (n = 6), with troncular vagotomy and pyloroplasty (n = 24) and single suture (n = 1), A conversion into lapa rotomy was necessary in 13 patients (29.5%). There was no mediastinitis, no postoperative death. Peritonitis by leakage occured in two patients who we re reoperated by laparotomy; mean duration of hospital stay was 5.5 days. W ith a one-year follow-up, all patients were in good condition, free of pain . Conclusion: With laparoscopic surgery, diagnosis of peptic ulcer perforatio n was confirmed, peritoneal lavage was perfectly done, duodenal perforation was sutured and surgical treatment of the peptic ulcer disease was perform ed, which is important in poor countries, (C) 2000 Editions scientifiques e t medicales Elsevier SAS.