Single stitch laparoscopic omental patch repair of perforated peptic ulcer

The standard treatment for perforated peptic ulcers in most institutions is omental patch repair and lavage. A laparoscopic approach is attractive because of the simplicity of the procedure. Most of the previously described laparoscopic methods required multiple working ports and multiple stitches. We employed three operating ports and applied a single stitch to close small peptic ulcer perforations. Prospective evaluations of the initial 33 cases of laparoscopic patch repair have confirmed its safety. There were five conversions, two for large perforations (> 10 mm), two for perforated gastric ulcers and the remaining one was converted because of bleeding. One patient early in the series with a 10-mm perforation suffered from radiological leakage after repair, which required secondary intervention. The mean operating time was 50 min. Patients, on average, require one dose of intramuscular pethidine (1 mg/kg body weight) for pain relief. The mean hospital stay was 6 days and 97% of them returned to their daily activities within 10 days of the operation. There was no mortality.