Laparoscopic and endoscopic management of perforated duodenal ulcers

Igor S Malkov, A M Zaynutdinov, N A Veliyev, Marat R Tagirov, Ronald C Merrell
Journal of the American College of Surgeons 2004, 198 (3): 352-5

BACKGROUND: Acid peptic perforation of the duodenum remains a surgical challenge. Plication alone may be satisfactory management if the ulcer diathesis is medically controlled. Laparoscopic management for plication has been safely applied in a variety of populations. This study assessed a combination of endoscopy and laparoscopy to manage early duodenal perforation.

STUDY DESIGN: Forty-two patients with early (less than 12 hours) perforation were managed by laparoscopic plication and lavage. Endoscopy identified the site of perforation and guided repair in 35 of 42. All patients were followed with Helicobacter pylori treatment and examined by endoscopy at 3 months. Forty case control patients who had open procedures for duodenal perforation were evaluated for comparison.

RESULTS: Endoscopic/laparoscopic management was completely effective and compared favorably with open procedures with regard to surgical time and complications. Endoscopic snaring of omentum and pulling into the defect proved to be an effective adjunct for plication.

CONCLUSIONS: Endoscopic/laparoscopic repair of perforated duodenal ulcers is a safe and effective surgical tactic if followed by treatment for Helicobacter pylori.

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