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Review
. 2002 Oct-Dec;6(4):359-68.

The sixth decision regarding perforated duodenal ulcer

Sandhya Lagoo  1 , Ross L McMahon, Minoru Kakihara, Theodore N Pappas, Steve Eubanks
Affiliations
Review

The sixth decision regarding perforated duodenal ulcer

Sandhya Lagoo et al. JSLS. 2002 Oct-Dec.

Abstract

This presentation reviews the literature regarding the current surgical treatment of perforated ulcers, describes the surgical techniques for laparoscopic repair, and reviews the clinical algorithm used by laparoscopic surgeons at Duke University Medical Center.

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Figures

Figure 1.
Figure 1.
Three sutures are placed through viable duodenum on either side of the perforation and tied to close the perforation. Reproduced with permission from Shah AS, Pappas TN. Atlas of Laparoscopic Surgery. In: Pappas TN, Chekan EG, Eubanks S, eds. Laparoscopic Repair of Perforated Ulcer and Vagotomy. Philadelphia, Pa: Current Medicine; 1999.
Figure 2.
Figure 2.
Laparoscopic suturing of a pedicle of omentum placed across the perforation completes the Graham patch. Reproduced with permission from Shah AS, Pappas TN. Atlas of Laparoscopic Surgery. In: Pappas TN, Chekan EG, Eubanks S, eds. Laparoscopic Repair of Perforated Ulcer and Vagotomy. Philadelphia, Pa: Current Medicine; 1999.
Figure 3.
Figure 3.
Repair of duodenal perforation with omentopexy alone. Reproduced with permission from Baker RJ. Mastery of Surgery. In: Nyhus LM, Baker RJ, Fischer JE, eds. Operation for Acute Perforated Duodenal Ulcer. London: Little, Brown and Company; 1997.
Figure 4.
Figure 4.
A. Suture repair of viable opposable edges of the duodenal perforation and reinforcement with an omental patch. B. Omentum plugs the hole of the perforation. Reproduced with permission from Baker RJ. Mastery of Surgery. In: Nyhus LM, Baker RJ, Fischer JE, eds. Operation for Acute Perforated Duodenal Ulcer. London: Little, Brown and Company; 1997.
Figure 5.
Figure 5.
The Duke Medical Center algorithm for management of a suspected perforated duodenal ulcer.
See this image and copyright information in PMC

References

    1. Feliciano DV. Do perforated duodenal ulcers need an acid-decreasing surgical procedure now that omeprazole is available? Surg Clin North Am. 1992;72(2):369–380 - PubMed
    1. Graham RR. The surgeon's problem in duodenal ulcer. Am J Surg. 1938;40:102–117
    1. Mouret P, Francois Y, Vignal J, et al. Laparoscopic treatment of perforated peptic ulcer. Br J Surg. 1990;77(9):1006. - PubMed
    1. Darzi A, Carey PD, Menzies-Gow N, Monson JR. Preliminary results of laparoscopic repair of perforated duodenal ulcers. Surg Laparosc Endosc. 1993;3(3):161–163 - PubMed
    1. Urbano D, Rossi M, De Simone P, et al. Alternative laparoscopic management of perforated peptic ulcers. Surg Endosc. 1994;8(10):1208–1211 - PubMed

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