Laparoscopic repair of perforated peptic ulcer with delayed presentation.

BACKGROUND: Laparoscopic repair has been used to treat perforated peptic ulcers since 1990 and is gaining acceptance. The main concerns are postoperative intra-abdominal collections and performing laparoscopy in the presence of peritonitis.

METHODS: From June 2006 to June 2008, 31 patients presenting with a clinical diagnosis of perforated peptic ulcer with peritonitis who underwent laparoscopic omental patch repair were selected. Patients who presented more than 24 hours after the onset of pain were only included for this analysis. Conversion criteria were malignant ulcers, perforations larger than 10 mm, or for technical difficulties. The degree of peritonitis was noted and a thorough wash given. The perforation was repaired by the standard omental patch technique, and the number of sutures were decided according to the size of the perforation. Endpoints were operative time, postoperative pain, length of postoperative hospital stay, and complications.

RESULTS: There were 2 conversions due to technical difficulties. Laparoscopic repair required an average of 105 minutes to complete. The median postoperative stay was 5.5 days while mean duration of pain was 3 days. Four patients had port-site infections and 5 had intra-abdominal collections, which were managed conservatively. There were no chest infections or mortality in our series.

CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer is a safe, reliable procedure even in delayed presentations with peritonitis. It has an acceptable morbidity and all the advantages of the minimally invasive surgical approach.