Laparoscopic plication of perforated ulcer: results of a selective approach

We reviewed our experience with laparoscopy for perforated ulcer from April 1, 1992, to March 31, 1993. All patients admitted to the gastrointestinal surgery service with a diagnosis of perforated viscus had evaluation for possible laparoscopic Graham plication (LGP). Of eight patients considered, five had successful diagnostic laparoscopy. Two patients with anterior duodenal ulcers had LGP. Operative times were 85 and 106 minutes; postoperative stays were 5 and 8 days. Three procedures were converted to formal laparotomy when laparoscopy revealed gastric or prepyloric ulcers. Three patients had immediate laparotomy because of known disease process. Two additional patients were treated with open plication by other surgeons; their operative times were 98 and 110 minutes and postoperative stays, 6 and 4 days. Hospital charges averaged $6,573 for the two laparoscopic plications, $7,511 for the four plications not done laparoscopically, and $20,995 for the two cases converted to open plication. A selective approach allowed two Graham patch closures to be done laparoscopically without complications, at a cost comparable to that of open surgery.