Abstract
Background
“Three-stitch” laparoscopic Graham patch repair (LGPR) for perforated duodenal ulcer enjoyed the same advantage as open Graham patch repair. However, it was not a popular approach because it had problems of suture entanglement and difficult laparoscopic suturing and knotting. The authors describe their technique and results.
Methods
A prospective series from January 2000 to September 2004 was examined. In this study, 35 LGPRs were performed for 32 males and 3 females with a median age of 47 years (range, 18–76 years).
Results
No conversion occurred for any of the 35 LGPRs attempted. The median perforation size was 5 mm (3–10 mm), and the median operative time was 86 min (range, 55–163 min). The median time for ambulation was day 2, and the median time for discharge was day 4. Morbidity was 11%, involving one chest infection, one retention of urine, one pelvic collection, and one pyloric stenosis. There was no reoperation, leakage, or mortality.
Conclusion
The authors’ LGPR technique was safe and efficient, and might be the choice for laparoscopic repair of relatively large perforations.
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References
Arnaud JP, Tuech JJ, Bergamaschi R, Pessaux P, Regenet N (2002) Laparoscopic suture closure of perforated duodenal peptic ulcer. Surg Laparosc Percutan Tech 12: 145–147
Cougard P, Barrat C, Gayral F, Cadiere GB, Meyer C, Fagniez L, Bouillot JL, Boissel P, Samama G, Champault G (2000) Laparoscopic treatment of perforated duodenal ulcers: results of a retrospective multicentris study. French Society of Lapaoroscopic Surgery. Ann Chir 125: 726–731
Cuschierri A, Szabo Z (1995) Tissue approximation in endoscopic surgery, Isis Medical Ltd, UK
Darzi A, Cheshire NJ, Somers SS, Super PA, Guillou PJ, Monson JRT (1993) Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler. Br J Surg 80: 1552
Druart ML, Van Hee R, Etienne J, Cadiere GB, Gigot JF, Legrand M, Limbosch JM, Navez B, Tugilimana M, Van Vyve E, Vereecken, Wibin E, Yvergneaux JP (1997) Laparoscopic repair of perforated duodenal ulcer: a prospective multicenter clinical trial. Surg Endosc 11: 1017–1020
Graham RR (1938) Technical surgical procedures for gastric and duodenal ulcer. Surg Gynecol Obstet 66: 269–287
Jennings WC (1993) Laparoscopic repair of perforated duodenal ulcer by Graham omentopexy. J Okla State Med Assoc 86: 383–384
Katkhouda N, Mavor E, Mason RJ, Campos GM, Soroushyari A, Berne TV (1999) Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134: 845–850
Koninger J, Bottinger P, Redecke J, Butters M (2004) Laparoscopic repair of perforated gastroduodenal ulcer by running suture. Langenbecks Arch Surg 389:11–16
Lau H (2004) Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc 18:1013–1021
Lau WY, Leung KL, Kwong KH, Davey IC, Robertson C, Dawson JJW, Chung SCS, Li AKC (1996) A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224: 131–138
Lau WY, Leung KL, Zhu XL, Lam YH, Chung SCS, Li AKC (1995) Laparoscopic repair of perforated peptic ulcer. Br J Surg 82:814–816
Mouret P, Francois Y, Vignal J, Barth X, Lombard-Platet R (1990) Laparoscopic treatment of perforated peptic ulcer. Br J Surg 77: 1006
Munro WS, Bajwa F, Menzies D (1996) Laparoscopic repair of perforated duodenal ulcers with a falciform ligament patch. Ann R Coll Surg Engl 78: 390–391
Siu WT, Leong HT, Law BKB, Chau CH, Li ACN, Fung KH, Tai YP, Li MKW (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235:313–319
So JBY, Kum ML, Fernandes ML, Goh P (1996) Comparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer. Surg Endosc 10:1060–1063
Takeuchi H, Kawano T, Toda T, Minamisono Y, Hagasaki S, Sugimachi K (1998) Laparoscopic repair for perforation of duodenal ulcer with omental patch: report of initial six cases. Surg Laparosc Endosc 8:153–156
Wemyss-Holden S, White S, Robertson G, Lloyd D (2002) Color coding of sutures in laparoscopic perforated duodenal ulcer: a new concept. Surg Laparosc Endosc Percutan Tech 12: 177–179
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Lam, P.W.F., Lam, M.C.S., Hui, E.K.L. et al. Laparoscopic repair of perforated duodenal ulcers: the“three-stitch” Graham patch technique. Surg Endosc 19, 1627–1630 (2005). https://doi.org/10.1007/s00464-005-0020-1
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DOI: https://doi.org/10.1007/s00464-005-0020-1