Laparoscopic management of perforated peptic ulcer using combined suturing and fibrin glue patch

Background: Duodenal perforation is a common complication of duodenal ulcer. Treatment for perforated peptic ulcer can be performed by laparoscopy in 85% of cases, making it possible to avoid a median laparotomy  which can lead to wound infection and late incisional hernia. Methods: Twenty-four patients  with perforated  peptic  ulcer  were planned  to be treated laproscopically,  three of whom were excluded from the study (one patient with previous upper abdominal operations, one with bleeding peptic ulcer and the third one had evidence of gastric outlet obstruction).The study started.from January 2009 till December 2010.Five patients were operated in Ain Shams University hospitals  (Egypt) and sixteen patients were operated upon in Kingdom of Saudi Arabia. Mean age was (38.1±10.3), diagnosis of perforated peptic ulcer was reached usual by clinical examination, laboratory investigations, plain X-ray chest, abdomen and abdominal U/S. One case was misdiagnosed originally as acute appendicitis.All operations were performed  by laparoscopy; closing  the perforation with intra-corporeal sutures  and application of fibrin glue patch. Results: Mean  operating time was 65 minutes. All procedures included  suturing  of the perforation with application of fibrin glue patch with peritoneal toilet and suction drain.Mean hospital stay was 3.5days. All patients had no serious postoperative complications apart from three patients, two of them developed chest infection and the third patient had postoperative leak and peritonitis. Conclusion: Laparoscopic  closure of peptic ulcer is safe with short hospital stay and early return to work.