Combined laparoscopic-endoscopic method using an omental plug for therapy of gastroduodenal ulcer perforation.
BACKGROUND
Laparoscopic techniques have been proposed as an alternative to open surgery for therapy of peptic ulcer perforation. They provide better postoperative comfort and absence of parietal complications, but leakage occurs in 5% of cases. We describe a new method combining laparoscopy and endoluminal endoscopy, designed to ensure complete closure of the perforation.


METHODS
Six patients with anterior ulcer perforations (4 duodenal, 2 gastric) underwent a concomitant laparoscopy and endoluminal endoscopy with closure of the orifice by an omental plug attracted into the digestive tract.


RESULTS
All perforations were sealed. The mean operating time was 72 minutes. The mean hospital stay was 5.5 days. There was no morbidity and no mortality. At the 30-day evaluation all ulcers but one (due to Helicobacter pylori persistence) were healed.


CONCLUSIONS
This method is safe and effective. Its advantages compared with open surgery or laparoscopic patching as well as its cost-effectiveness should be studied in prospective randomized trials.
Pescatore
P
P
Division de Gastroentérologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Halkic
N
N
Calmes
J M
JM
Blum
A
A
Gillet
M
M
D000328:Adult; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000150:complications / Q000382:microbiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009852:Omentum / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications; D013997:Time Factors