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Laparoscopic repair of perforated peptic ulcer with delayed presentation

Beena B Vaidya1, Chaitanya P Garg, Jignesh B Shah

  • 1Department of Surgery, Government Medical College and New Civil Hospital, Surat, India.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|February 17, 2009
PubMed

Insights

Laparoscopic repair of perforated peptic ulcers is safe and effective, even with peritonitis. This minimally invasive approach offers acceptable complications and benefits for patients with delayed presentation.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Minimally Invasive Surgery

Background:

  • Laparoscopic repair for perforated peptic ulcers (PPU) has been utilized since 1990.
  • Key concerns include postoperative intra-abdominal collections and performing laparoscopy during peritonitis.

Purpose of the Study:

  • To evaluate the safety and efficacy of laparoscopic omental patch repair for perforated peptic ulcers with peritonitis.
  • To assess outcomes in patients with delayed presentation (over 24 hours).

Main Methods:

  • A prospective analysis of 31 patients with PPU and peritonitis undergoing laparoscopic omental patch repair.
  • Inclusion criteria: clinical diagnosis of PPU with peritonitis, presentation >24 hours after pain onset.
  • Exclusion criteria: malignant ulcers, perforations >10 mm, or technical difficulties necessitating conversion.

Main Results:

  • Two conversions to open surgery were required due to technical difficulties.
  • Average operative time was 105 minutes; median postoperative hospital stay was 5.5 days.
  • Complications included 4 port-site infections and 5 conservatively managed intra-abdominal collections; no mortality or chest infections occurred.

Conclusions:

  • Laparoscopic repair of PPU is a safe and reliable option, even in cases with peritonitis and delayed presentation.
  • The procedure demonstrates acceptable morbidity and leverages the benefits of minimally invasive surgery.
Abstract

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