Laparoscopic treatment of duodenal perforated peptic ulcer

This video demonstrates laparoscopic repair of a perforated duodenal ulcer with peritonitis. The ulcer is in the anterior wall of the duodenum, which is closed with two absorbable interrupted sutures. After full lavage of the abdominal cavity a drain is inserted and the area of the closure is covered with fibrin glue.

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Laparoscopic treatment of duodenal perforated peptic ulcer

Authors

M Simone, J Marescaux

Abstract

This video demonstrates laparoscopic repair of a perforated duodenal ulcer with peritonitis. The ulcer is in the anterior wall of the duodenum, which is closed with two absorbable interrupted sutures. After full lavage of the abdominal cavity a drain is inserted and the area of the closure is covered with fibrin glue.

Classification

complex cases

Keywords

laparoscopic, perforated duodenal ulcer, peritonitis

Media type

Surgical video

Duration

05'00''

Publication

2004-12

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E-publication

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1698.htm

Laparoscopic treatment of duodenal perforated peptic ulcer

1. Trocar and patient position 00'10''

This is the case history of a 41-year-old male patient presenting to the emergency care unit. He’s suffering from acute epigastric pain. Also he’s presenting with an inflammatory syndrome and pneumoperitoneum noted on plain film. A total of 4 trocars are placed: one just below the xiphoid process, another approximately two thirds of difference from the hypochondrium to the umbilicus, and 2 additional ports placed in the left hypochondrium, and a final port placed lateral to the umbilicus. The surgeon stands between the patient’s legs and the assistant stands to the patient’s left.

2. Exploration 00'49''

After pneumoperitoneum was established, during exploration of the abdominal cavity, purulent fluid is found, noted within the level of the right hypochondrium. Exploration helps to identify the presence of the duodenal bulb as seen here within of a perforated peptic ulcer.

3. Suturing 01'14''

Suturing of the ulcer is performed with 2 sutures of 2/0 polyglactin suture material. Successful retraction of the liver is noted here with the use of the left hypochondrium port. As the patient is noted to be septic, we will perform the suturing of the ulcer and lavage and complete our procedure.

4. Lavage of abdominal cavity 02'03''

After the sutures are completed, the abdominal cavity is washed with saline.

5. Biological glue and drainage 02'51''

At this time, we will also apply a biological glue along the suture line. Upon completion of a biological glue, we will place a drain to collect the sub-hepatic collections we anticipate. The catheter will be left in place for approximately 5 days. This patient did quite well and was discharged on the 5th postoperative day and the patient is currently on protein pump inhibitor therapy as well as therapy for pylori infection.