Abstract
Surgery—namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers.
We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31–81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6–15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months.
On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.
Similar content being viewed by others
References
Ball ABS, Thomas PA, Evans SJ (1989) Operative mortality after perforated peptic ulcer. Br J Surg 76: 521–522
Bardhan KD, Cust G, Hincliffe RFC, Williamson FM, Lyon C, Bose K (1988) Changing pattern of admissions and operations for duodenal ulcer. Br J Surg 76: 230–236
Bornman PC, Theodorou NA, Jeffery PC, Marks IN, Essel HP, Wright JP, Terblanche J (1990) Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg 77: 73–75
Berne TV, Donovan AJ (1989) Nonoperative treatment of perforated duodenal ulcer. Arch Surg 124: 830–832
Ceneviva R, de Castro e Silva O Jr, Castelfranchi PL, Módena JLP, Santos RF (1986) Simple suture with or without proximal gastric vagotomy for perforated duodenal ulcer. Br J Surg 73: 427–430
Christensen A, Bousfield R, Christiansen J (1988) Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2-receptor antagonists. Ann Surg 207(1): 4–6
Costalat G, Dravet F (1991) Traitement des perforations d'ulcère gastro-duodénal sous coelioscopie avec utilisation du ligament rond. J Chir 128(2): 91–93
Crofts TJ, Park KGM, Steele RJC, Chung SSC, Li AKC (1989) A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 320: 970–973
George RL, Smith IF (1991) Long-term results after omental patch repair in patients with perforated duodenal ulcers: a 5- to 10-year follow-up study. Can J Surg 34(5): 447–449
Keane TE, Dillon B, Afdhal NH, McCormack CJ (1988) Conservative management of perforated duodenal ulcer. Br J Surg 75: 583–584
Kristensen ES (1980) Conservative treatment of perforated peptic ulcer. Acta Chir Scand 146: 189–193
Mouret P, François Y, Vignal J, Barth X, Lombard-Platet R (1990) Laparoscopic treatment of perforated peptic ulcer. Br J Surg 77: 1006
Perrotin J, Simon PH (1975) Interèt de la mèthode de Taylor dans le traitement des ulcères perforés gastroduodénaux. Ann Chir 29: 143–149
Raimes SA, Devlin HB (1987) Perforated duodenal ulcer. Br J Surg 74: 81–82
Tate JJT, Dawson JW (1993) Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 80: 235
Taylor H (1946) Perforated peptic ulcer treated without operation. Lancet, ii: 441–444
Taylor H (1957) The non-surgical treatment of perforated peptic ulcer. Gastroenterology 33(3): 353–368
Werbin N, Kashtan H, Wasserman I, Wiznitzer T (1990) Perforated duodenal ulcer in the elderly patient. Can J Surg 33(2): 143–144
Conservative management of perforated peptic ulcer [Editorial] (1989). Lancet, ii: 1429–1430
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Urbano, D., Rossi, M., De Simone, P. et al. Alternative laparoscopic management of perforated peptic ulcers. Surg Endosc 8, 1208–1211 (1994). https://doi.org/10.1007/BF00591052
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00591052