Laparoscopic omental patch repair for perforated peptic ulcer

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. Summary Background Data: Since the advent of H₂-antagonists, the usefulness of simple closure of a perforated peptic ulcer is increasing, and improvements in laparoscopic surgery have made possible minimally invasive surgery for perforated ulcer. 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.