Laparoscopic repair of perforated peptic ulcer without drain

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Author: 
Dr. Osama Abdullah Abdul Raheem, Dr. Abd-EL-Aal A-Saleem, Dr. Hassan Ahmed Abdallah and Dr. Yaser A. Razek
Subject Area: 
Health Sciences
Abstract: 

Perforated duodenal ulcer is a common surgical emergency and the most common cause of peritonitis. Despite antiulcer medication and Helicobacter eradication, Perforated peptic ulcer (PPU), is still the most common indication for emergency gastric surgery and is associated with high morbidity and mortality. The outcome might be improved by performing this procedure laparoscopically. Laparoscopic omental patch repair of perforated peptic ulcer carries less morbidity and mortality and early return of patients to their normal dailyroutine. Patient and methods: This study was conducted in Aswan University Hospital on 30 male patients between April 2014 and July 2015 who underwent laparoscopic repair of perforatedpeptic duodenal ulcer. The patients were admitted in urgent setting. A detailed history was taken, all patient past history of gastritis or on medication of NSAID drugs. The patients were examined and showed surgical abdomen with board like rigidity. Main diagnostic procedure we performed was abdominal X-ray in erect position. In 9 cases, additional abdominal ultrasound examination was carried out. A standard work-up was performed. Postoperative data willbe recorded including: Operating time, Amount of postoperative analgesia, Duration of hospital stay, Post operative collection, Time needed for returning to work, Low grade fever, Vomiting and Wound infection. All the above data will be collected and analyzed to obtain statistically relevant results. Results: There were 30 patients who underwent laparoscopic repair of perforatedpeptic duodenal ulcer. No conversion was happened for any of the 30 patient attempted. All patient was male; mean age was 28.5 (range 25–35) years. In all cases close of perforation with omental patch only. Mean duration of the operation was 65 (range 55–80) minutes. Mean postoperative hospital stay was 5 (range 5–7) days. Only one patient (3.3%) developed fever, tachycardia, abdominal pain and leucocytosis, abdominal U/S was done for him, and showed subhepatic collection which was drained by percutaneous drainage. Two patients (6.6%) developed wound infection and treated with local dressing. About eight patients suffered from port site pain post-operative (26%) and treated with single dose of pethidine. All patients return to work within one week after discharge from hospital. Conclusion: Laparoscopic repair of a perforated peptic ulcer is an amenable and feasible technique within the hands of experienced laparoscopic surgeon. No need to put drain after lap repair of perforated duodenal ulcer provided good wash, suction and movement of patient up and down to suck fluid.

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