Laparoscopic vs open plication of perforated duodenal ulcer

Summary

Between September 1991 and September 1994, 22 plications for perforated duodenal ulcers were performed. Twelve patients were treated through an open midline laparotomy, in 10 cases the perforated ulcer was sutured laparoscopically. The modality of closure was decided by the surgeon on duty, depending on his experience of laparoscopic surgery. The laparoscopic closure was done with an intracorporal knotting technique. In one patient a laparotomy had to be performed for peritonitis after laparoscopic closure. One patient in each group died of complications related to sepsis. No other complications in either group occurred. Routine post-operative gastroscopy after 3–5 weeks showed in every case a healed ulcer without signs of stenosis. The post-operative course showed no significant differences in either group concerning return to normal feeding, nasogastric tube stay, abdominal drain removal time or medical therapy. Therefore we conclude: laparoscopic plication for perforated duodenal ulcers is a safe procedure with the benefit of minimal invasive therapy.

Key Words:

• perforated duodenal ulcer
• suture plication
• laparoscopic management