Laparoscopic treatment of perforated duodenal ulcer

OBJECTIVE: Laparoscopic treatment of perforated duodenal ulcer is an altern ative to laparotomy. We reviewed our experience to determine feasibility an d reliability of the surgical procedure and the subsequent morbidity and mo rtality. PATIENTS AND METHODS: This was a retrospective series of 35 patients who un derwent laparoscopic repair of perforated duodenal ulcers between January 1 994 and November 1999. The perforation was dosed by interrupted sutures in 86% of cases associated with irrigation-suction of the abdominal cavity. RESULTS: Two complications were observed: pyloric stenosis in one patient w ith a large perforation and Douglas pouch abscess in another. Conversion to laparotomy was necessary in 8 cases: in 2 of them the edges of the perfora tion were fragile, in 3 the perforation could not be identified (posterior position), and in 3 intraabdominal adhesions were important. There were no deaths. The 2-year results are quite satisfactory. CONCLUSION: This study shows that the laparoscopic procedure is reliable an d adapted to treat ulcer perforation if the size is less than 1 cm.