TITLE:
Laparoscopic Management of Perforated Peptic Ulcer: Simple Closure or Something More?
AUTHORS:
Periklis Karydakis, Dmitry Iu. Semenov, Alexandros V. Kyriakidis, Zeynur Kh. Osmanov, Iraklis Perysinakis, Elena Did-Zurabova, Yuriy S. Chekmasov, Lyssandros Karydakis, Vladimiros Kyriakidis
KEYWORDS:
Peptic Ulcer Perforation, Laparoscopy, Graham Patch, Taylor Procedure, Recurrence Rate
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.6 No.11,
November
9,
2016
ABSTRACT: Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has
gained wide acceptance over the traditional open repair on the basis of being an
equally efficient and less invasive technique. Methods: 198 patients
with perforated duodenal or prepyloric ulcer that were surgically treated from 2003
to 2014 were included in this study. 140 were operated within 2 - 6 hours from the
onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic
simple closure with Graham patch was performed in 179 patients. In 19 patients with
known chronic ulcer resistant to pharmacologic therapy, who were operated within
6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken.
Conversion to open repair was necessitated in four patients. The operating time
was 40 - 100 min for the Graham patch repair and 120 - 155 min
for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch”
group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic
treatment of perforated peptic ulcer is technically feasible and safe when performed
by experienced surgeons. In certain cases more definitive procedures may achieve
better long-term results.