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Objective
The authors' initial experience with laparoscopic omental patch repair for perforated peptic ulcer is
documented. Its results are compared with those of other procedures and follow-up study is
reviewed.
Methods
From December 1992 to February 1994, laparoscopic omental patch repair followed by use of H2-
antagonists was performed successfully in 11 patients. Fifty-five patients underwent other surgical
procedures for perforated peptic ulcers (conventional open omental patch: 4, selective vagotomy
in combination with antrectomy: 24, distal gastrectomy: 27).
Results
The average operation time was 135 minutes. Administration of postoperative pain medication
was reduced remarkably (0.9 times per patient), and all patients recovered rapidly. No serious
postoperative complications were recorded. After a mean period of 11 months, the postoperative
evaluation was satisfactory for all patients, and no ulcer recurrence was found.
Conclusions
In perforated peptic ulcer disease, laparoscopic omental patch repair offers a number of
advantages. Because no upper abdominal incision is made, there is decreased postoperative
pain, and the patient rapidly recovers with fewer and less severe complications. Although the
procedure requires a surgeon with particular expertise in endoscopic suturing technique,
surgeons familiar with laparoscopic cholecystectomy can readily perform it after some practice.
The authors' preliminary experience suggests that this is a minimally invasive procedure for
perforated peptic ulcer that offers an attractive alternative to open surgery.
Since the advent of H2-antagonists, supplemented re- procedures for intractable peptic ulcer has decreased dra-
cently by omeprazole, the frequency of the use ofsurgical matically.' The use of simple closure of perforated peptic
ulcer, in combination with postoperative use of H2-
Address reprint requests to Masao Matsuda M.D., Department of Sur- blocking drugs, also has been increasing.2 Laparoscopic
gery, Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, Japan. surgery has revolutionized the practice of cholecystec-
Accepted for publication August 16, 1994. tomy and has led to the development of a wide range of
236
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Vol. 221 * No. 3 Laparoscopic Repair for Perforated Ulcer 237
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nation with antrectomies, and 27 patients with distal gas- \ if iE.D i,
1 st assistant
trectomies. The details on patients' background of each
group are shown in Table 1. operator
The results of these surgical procedures were recorded
with reference to operative time, postoperative pain
medication, period of hospitalization, dietary condition
after operation, and morbidity and mortality rates. Ten
of the 11 patients who underwent laparoscopic omental
patch repair were observed for follow-up for a mean pe- 2nd assistant
riod of 11 months (range 3-18 months). Figure 1. Sites of insertion of ports
238 Matsuda and Others Ann. Surg. * March 1995