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Paper Information

Journal:   IRANIAN JOURNAL OF SURGERY   2004 , Volume 12 , Number 33; Page(s) 35 To 40.



Introduction & Objective: Despite the decline in the incidence of peptic ulcer disease, neither the incidence nor the need for surgery for the emergent complications of ulcer has changed significantly during the past three decades. The medical treatment of peptic ulcer is highly successful, and eradication of H. pylori reduces ulcer recurrence. Thus, precious complex acid - reducing procedures are substituted by simple closure of the perforation with for without an omental patch or by suture less techniques. Laparoscopic techniques for Perforated Peptic Ulcer (PPU) have evolved in the past few years and non - randomized and randomized studies suggest that laparoscopic repair is feasible, efficacious and safe. In this study we have reviewed the role of laparoscopy in management of PPU.
Material & Methods: We have reviewed a series of 14 patients with PPU who underwent laparoscopic surgery in Arad general hospital, between 1995-2003. All of the procedures were done by an experienced laparoscopic surgeon. Three ports were inserted in abdominal wall. Simple closure of the perforation with one or a few simple sutures by 2/0 silk and irrigation of the abdominal cavity using 6-8 liters of normal saline was performed. In 50% of patients an omental patch was fixed to the site of repair.
Results: 12 patients (86%) were male. The mean duration of pain was 30 hours (12-96 hrs), the mean operating time was 75±12 min (60-120 min), and the mean hospital stay was 4±2.1 (:3-8) days. Over all success rate was 86% and conversion to laparoscopy was necessary in 2 cases due to a giant ulcer in one case and inadequate localization in the other. Only one patient (7%) was re-operated two weeks later because of severe pyloric deformity that caused gastric outlet obstruction. There was no mortality and the mean follow up time was 5 years (6 months to 8 years).
Conclusions: Finally we conclude that laparoscopic repair of PPU is technically feasible, safe and not only carries an acceptable results compared with convectional surgery, but also has some advantages eg.: less scarring, lower incidence of incision hernia, wound infection, post operative pain and shorter convalescence period for patients.

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