30
ACUTE ABDOMINAL PAIN Alonzo.Amaro.Amolenda Anacta.Andal
ACUTE ABDOMINAL PAIN
AlonzoAmaroAmolendaAnactaAndal
Beginning Data Male 45 year old Chief Complain Severe Abdominal Pain
History of Present Illness
3 years PTA
bull Crampy epigastric painbull Relieved by food intake or
antacidsbull Melenabull UGI endoscopy Erosive Gastritisbull Unrecalled medications
1 year PTA
bull Epigastric pain bull Melena bull Self‐medicated Omeprazole
A few hours PTA
bull Severe epigastric pain
ADMISSION
History of Present Illness
Past Medical History(-) HPN(-) DM
Family History(-) Cancer
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Beginning Data Male 45 year old Chief Complain Severe Abdominal Pain
History of Present Illness
3 years PTA
bull Crampy epigastric painbull Relieved by food intake or
antacidsbull Melenabull UGI endoscopy Erosive Gastritisbull Unrecalled medications
1 year PTA
bull Epigastric pain bull Melena bull Self‐medicated Omeprazole
A few hours PTA
bull Severe epigastric pain
ADMISSION
History of Present Illness
Past Medical History(-) HPN(-) DM
Family History(-) Cancer
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
History of Present Illness
3 years PTA
bull Crampy epigastric painbull Relieved by food intake or
antacidsbull Melenabull UGI endoscopy Erosive Gastritisbull Unrecalled medications
1 year PTA
bull Epigastric pain bull Melena bull Self‐medicated Omeprazole
A few hours PTA
bull Severe epigastric pain
ADMISSION
History of Present Illness
Past Medical History(-) HPN(-) DM
Family History(-) Cancer
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
A few hours PTA
bull Severe epigastric pain
ADMISSION
History of Present Illness
Past Medical History(-) HPN(-) DM
Family History(-) Cancer
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Past Medical History(-) HPN(-) DM
Family History(-) Cancer
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Personal History
bull 10 pack‐years smoking bull Drinks alcoholic beverage for 8 years
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Physical Examination Conscious coherent in distress BP= 14090 PR= 105min RR=26min T=
378 C Warm moist skin no active dermatoses Pink palpebral conjunctivae anicteric sclerae Heart and Lungs regular rate and rhythm
clear breath sounds Abdomen flat hypoactive bowel sounds 1057303
guarding and tenderness on all quadrants DRE brown stool on tactating finger
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Salient FeaturesPertinent Subjective
Male 45 yo Crampy epigastric pain Relieved by food intake or
antacids Melena UGI endoscopy Erosive
Gastritis 10 pack‐years smoking Drinks alcoholic beverage
for 8 years
Pertinent Objective
bull PR= 105min RR=26min
bull Abdomen flat hypoactive bowel sounds (+) guarding and tenderness on all quadrants
bull DRE brown stool on tactating finger
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Clinical Impression Peptic Perforation
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Initial Diagnostic Measures for Perforated PUD Upright CXR or lateral abdominal
decubitus radiography Upper GI contrast study with water
soluble contrast
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Initial Therapeutic Measures for Perforated PUD Fluid resuscitation with replacement of
fluid and electrolytes Nasogastric decompression Administer broad spectrum antibiotics Insert Foley catheter Insert central venous line or Swan-Ganz
artery catheter
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
TREATMENT PLAN
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Surgical Therapy Surgery is recommended in patients who
present with the followingHemodynamic instabilitySigns of peritonitisFree extravasation of contrast on upper GI
contrast studies
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Preoperative Management Fluid resuscitation NGT insertion Insertion of Foley catheter Broad-spectrum antibiotics
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Intraoperative Details Exploratory Laparotomy life-threatening comorbid conditions amp
severe intraabdominal contamination Graham patch using omentumSeveral full-thickness simple sutures are
placed across the perforation A segment of omentum is placed over the
perforation amp silk sutures are secured
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
OMENTAL PATCH
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Intraoperative details Minimal contamination stable patient
highly selective vagotomytruncal vagotomy and pyloroplastyvagotomy and antrectomy
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Postoperative Details NGT can be discontinued on
postoperative day 2 or 3 depending on the return of GI function and diet can be slowly advanced
H pylori infectionantibiotic regimen Follow-up with an upper endoscopy to
evaluate the area of ulcer and healing of the perforation site 4-6 weeks after surgery
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Possible Complications Pneumonia (30) Wound infection abdominal abscess
(15) Cardiac problems (especially in those
gt70 y) Diarrhea (30 after vagotomy) Dumping syndromes (10 after
vagotomy and drainage procedures) Gastric outlet obstruction Recurrent peptic ulcer
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Laparoscopic Surgery in Peptic Perforation Closure Comparative Study Of Laparoscopic
Versus Open Peptic Perforation Closure
January 2008 MM Porecha MS et al MP Shah Medical College and GG Hospital
Jamnagar India
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Laparoscopic Surgery in Peptic Perforation Closure Objective
To evaluate safety amp efficacy of laparoscopoic repair for perforated peptic ulcer in routine clinical practice
To evaluate whether it is justifiable to perform laparoscopic peptic perforation closure and to find out and evaluate whether it can stand against conventional laparotomy to treat peptic perforation
To evaluate whether laparoscopic peptic perforation closure is better than conventional laparotomy for peptic perforation closure in terms of benefits of minimal invasive surgery
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Laparoscopic Surgery in Peptic Perforation Closure Study
non ndash randomized and prospectivecomparative study
50 patients with peptic perforated ulcer 25 ndash 43 years old 25 patients ndash open repair 25 patients - laparoscopic
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
Conclusion laparoscopic suture with omental patch repair is an
attractive and superior alternative to conventional surgery with extraordinary benefits of minimal invasive surgery such as Shorter operative time and reduced postoperative pain Lesser requirement of nasogastric aspiration and lesser wound
infection Lesser blood loss and lesser transfusion requirement Shorter hospital stay and early rehabilitation Earlier resumption of oral feeding and lesser antibiotic
requirement Lesser occurrence of incisional hernia and burst abdomen and
lesser occurrence of pelvic abscess Earlier return to normal physical activity and earlier return to work
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
RISKSCOMPLICATIONS
Andal Charlotte
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
RISKS Elderly chronically ill and are taking one or
more ulcerogenic drugsMean age is gt60 yo
History of ulcer disease or symptoms of an ulcer is importantone-third of patients had a history of PUD32 of patients who presented with perforation
were taking H2 blockers antacids or both History of smoking alcohol abuse and
postoperative stress
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
COMPLICATIONS Gastric and duodenal contents may leak
into the peritoneumGastric and duodenal secretions bile ingested
food and swallowed bacteriaPeritonitisIncreased risk of infection and abscess
formation Third-spacing of fluid in the peritoneal cavity
Inadequate circulatory volume hypotension and decreased urine output
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
COMPLICATIONS More severe cases shock Abdominal distension as a result of
peritonitis and subsequent ileusMay interfere with diaphragmatic movement
impairing expansion of the lung bases Atelectasis
