Laparoscopic repair of perforated duodenal ulcer. A retrospective multicentric study

Study aim: The aim of this multicentric retrospective study was to report p rocedures, mortality and morbidity rate in a series of patients operated on for perforated duodenal ulcer with a laparoscopic approach. Patients and methods: Four-hundred and nineteen patients from 18 centers we re included. The duration of the study was ten years (1990 to 1999). There were 299 men and 120 women aged from 19 to 98 years (mean: 48 years). The A SA scores were as follows: I (48.7%), II (31.3%), III (17.5%), IV (2.5%). T he mean duration between the onset of perforation and the time of operation was 13.4 hours (range: 1-70), The surgical procedures were suture (76.7%), epiploplasty (9.9.%), only irrigation of the abdominal cavity (2.7%). Results: Conversion into laparotomy was performed in 10.6% of the patients. Mean operative time was 85 minutes. The morbidity and mortality rates were 13.4 and 1.4% respectively. Seventeen patients were reoperated because of fistula (n = 5), intra-abdominal abscess (n = 5), small bowel obstruction ( n = 4), bleeding ulcer (n = 1), iatrogenic perforation of the gallbladder ( n = 1) and small bowel (n = 1). Mean hospital stay was 8.5 days. All patien ts were discharged with a medical treatment of the peptic ulcer disease and in most of the cases, with antibiotics for Helicobacter pylori eradication . Six patients out of 96 with a medical history of chronic peptic ulcer und erwent a vagotomy. Conclusion: Laparoscopic repair of perforated duodenal ulcer is a safe opti on providing low rates of morbidity, reoperation and mortality, and can be considered the treatment of choice. (C) 2000 Editions scientifiques et medi cales Elsevier SAS.