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Laparoscopic repair of perforated duodenal ulcers: the"three-stitch" Graham patch technique
P W F Lam1, M C S Lam, E K L Hui
1Department of Surgery, Caritas Medical Centre, No. 111 Wing Hong Street, Shamshuipo, Hong Kong SAR, China. lamm@i-cable.com
Background:
"Three-stitch" laparoscopic Graham patch repair (LGPR) for perforated duodenal ulcer enjoyed the same advantage as open Graham patch repair. However, it was not a popular approach because it had problems of suture entanglement and difficult laparoscopic suturing and knotting. The authors describe their technique and results.
Methods:
A prospective series from January 2000 to September 2004 was examined. In this study, 35 LGPRs were performed for 32 males and 3 females with a median age of 47 years (range, 18-76 years).
Results:
No conversion occurred for any of the 35 LGPRs attempted. The median perforation size was 5 mm (3-10 mm), and the median operative time was 86 min (range, 55-163 min). The median time for ambulation was day 2, and the median time for discharge was day 4. Morbidity was 11%, involving one chest infection, one retention of urine, one pelvic collection, and one pyloric stenosis. There was no reoperation, leakage, or mortality.
Conclusion:
The authors' LGPR technique was safe and efficient, and might be the choice for laparoscopic repair of relatively large perforations.
