J Gastric Cancer.  2012 Dec;12(4):237-242.

Laparoscopic Primary Repair with Omentopexy for Duodenal Ulcer Perforation: A Single Institution Experience of 21 Cases

• Ma CH
• Kim MG

Abstract

PURPOSE
Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons.
MATERIALS AND METHODS
Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher.
RESULTS
During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (20~80 minutes). Median day of commencement of a soft diet was day 6 (4~17 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management.
CONCLUSIONS
Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.

Keyword

Duodenal ulcer; Perforation; Laproscopy; Primary repair

MeSH Terms

Conversion to Open Surgery
Diet
Duodenal Ulcer
Emergencies
Humans
Laparoscopy
Length of Stay
Peritoneal Lavage
Postoperative Complications
Sutures

Figure

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  Fig. 1 (A) Trocar placements for laparoscopic primary repair with omentopexy. (B) Grasping below 2 cm of needle. (C) Needle can move freely in and out of the troca. (D) Stitch of round needle in normal tissue. Op = operator; F.A = first assistant; Sc = scopist; S.N = scrub nurse.

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  Fig. 2 (A) Extract the needle out of the perforation site. (B) Extract the thread by apply the principle of pulley. (C) Knot pushing was done through right upper troca. (D) Omentum was placed above suture site.

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