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KMID : 0371320000590030355
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Journal of the Korean Surgical Society
2000 Volume.59 No. 3 p.355 ~ p.363
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Suture Omentopexy of Perforated Duodenal Ulcer Laparoscopic vs. Open Surgery
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박관태/Kwan Tae Park
김선한/이상우/홍윤식/황정웅/Sun Han Kim/Sang Woo Lee/Yoon Sik Hong/Cheong Woong Whang
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Abstract
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Purpose: Perforated duodenal ulcer can be treated by variable methods ranging from non-operative management to immediate definitive acid-reduction surgery. With the current availability of potent H2 blocker, proton pump inhibitor, and effective
Helicobacter pylori (H. pylori) eradication regimens, ulcer recurrence is usually low and the need for definitive surgery has been reduced. Furthermore, the introduction of laparoscopic closure makes the principles of conventional surgical
approach
weakened at present and surgeons are faced with the choice of definitive surgery or omental patch repair, open or laparoscopic surgery. The aims of this study were to evaluate the feasibility and efficacy of laparoscopic omental patch repair in
comparison with conventional surgery and to investigate the status of H. pylori infection and the role of eradication of H. pylori. In addition, we tried to introduce our unique surgical experience using a 3-port technique. Methods: We treated 31
patients of perforated duodenal ulcer laparoscopically and compared with 30 patients operated by conventional omental patch repair. The patients treated by laparoscopy were evaluated for H. pylori status postoperatively. H. pylori infected
patients
received 1 or 2 weeks course of Omeprazole plus Amoxicillin and Clarithromycin. Results: Laparoscopic repair was successful in 26 cases and the conversion rate was 16.1%. There was no statistically significant difference in terms of operative
time
and
mortality. Morbidity was comparable between both groups, but the wound infection was more common in the open group. The clinical course and hospital stay were significantly shorter in the laparoscopic group. H. pylori infection rate was 47% and
there
were 2 cases of ulcer recurrence and 2 cases of reperforation in H. pylori negative patients. Conclusions: Laparoscopic closure of perforated duodenal ulcer using a 3-port technique is a technically feasible and safe alternative to open repair,
with
early recovery and low morbidity. H. pylori is positive in about half of perforated duodenal ulcer patients and should be eradicated in positive patients. Other risk factors on ulcer perforation should be identified.
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