Laparoscopic Management of Duodenal Perforation

 

Master Classes From World Laparoscopy Hospital

Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.

Despite of the wide availability of antiulcer medication and Helicobacter eradication, perforated peptic ulcer (PPU) is still an existing ailment that occurs commonly in the 21st century. Laparoscopy may improved the outcome of deodnal perforation if it's performer earlier. The treatment's result in terms of mortality, complications and stay in hospital by laparoscopy was analyzed.

BACKGROUND:

One of the remaining surgical challenges is acid peptic perforation of the duodenum. If the ulcer diathesis is medically controlled, plication alone can be a satisfactory management. In a variety of populations laparoscopic management for plication continues to be safely applied. Combination of laparoscopy and endoscopy to deal with early duodenal perforation was assessed with this study.

STUDY DESIGN:

Laparoscopic plication and lavage were utilised to cope with forty-two patients with untimely perforation. Site of perforation and guided repair in 35 of 42 were recognized by endoscopy. All patients were examined by endoscopy at 3 months and were followed with Helicobacter pylori treatment. To compare forty case control patients who have been operated with open procedures for duodenal perforation were evaluated.

RESULTS:

Endoscopic/laparoscopic management was completely successful and compared favourably with open procedures in terms of surgical time and complications. Snaring of omentum and pulling in to the defect turned out to be an effective adjunct for placation by endoscopy.

CONCLUSIONS:

If accompanied by strategy to Helicobacter pylori, repair of perforated duodenal ulcers works well and safe by Endoscopy or Laparoscopy.

This research was continued for 3 years beginning with July 2009 and ending on July 2012. One of them study were all patients with acute abdominal pain that was clinically diagnosed as having perforated peptic ulcer. Those patients with concomitant bleeding in the ulcer and proof of gastric outlet obstructions were excluded out of this study. Patients with the signs of greater than 36 h durations for fear of septic shock and patients with evidence of large perforation more than 10 mm were also excluded. Once the cases are early and effectively diagnosed Laparoscopic repair of the perforated peptic ulcer is an agreeable and practical technique that can be done by experienced laparoscopic surgeon.