LAPAROSCOPIC TREATMENT OF DUODENAL ULCER FEASIBILITY AND RESULTS : ABOUT 160 CASES

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Vol. 86 No. 2 (2008): Issue Feb 2008

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Slim Khelifi
Service de Chirurgie Générale Hôpital Habib Thameur
Ali Ben Ali
Service de Chirurgie Générale Hôpital Habib Thameur
Ahmed Bouhafa
Service de Chirurgie Générale Hôpital Habib Thameur
Souheil Zghidi
Service d'Anesthésie à Réanimation Hôpital Habib Thameur
Anis Ben Maamer
Service de Chirurgie Générale Hôpital Habib Thameur
Hazem Jaoua
Service d'Anesthésie à Réanimation Hôpital Habib Thameur
Abdelaziz Oueslati
Service de Chirurgie Générale Hôpital Habib Thameur
Fethi Ouertani
Service de Chirurgie Générale Hôpital Habib Thameur
Abderraouf Cherif
Service de Chirurgie Générale Hôpital Habib Thameur

Abstract

Aim : The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer.
Methods : One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists on a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pomp was conducted.
Results : The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases.A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases.Mean duration was 90 min (extremes 50 – 120 min). Complications occur in 3,1 %. They were post – operative peritonitis in 3 cases and duodenal fistulae in 2 cases.All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occurs in 4 cases because of no adhesion to medical treatment.
Conclusion : Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy.The actual efficacy of medical treatment mustn’t allow place to the radical treatment of ulcerous illness.

Keywords:

Coelioscopy, Peritonitis, Tritherapy, Duodenal ulcer

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References

  1. J. Isaac, Y. Tekant, K.C. Kiong, S.S. Ngoi, P. Goh. Laparoscopic repair of perforated duodenal ulcer. Gastrointest Endosc , 1194 ; 40 : 68 - 69.
  2. B.E. Stabil. Current surgical Management of duodenal ulcers. Surg Clin North Am, 1992 ; 72 : 335 - 356.
  3. A.R. Thompson, T.J. Hall, Anglin, C.E. Scott-Conner. Laparoscopic placation of perforated ulcer: results of a selective approach. South Med J, 1995 ; 88 : 185 - 189.
  4. G. Gostlat, F. Dravet, P. Noel, Y. Alquier, J. Vernhet. Coelioscopic treatment of perforated gastro duodenal ulcer using the ligamentum teres hepatis. Surg Endosc, 1995 ; 5 : 154 - 155.
  5. R. Semmar, A. Immouloudene, A. Zerrokni, M. Touami, F. Mokrane, B. Meradji. Ulcère duodénal perforé : intérêt du traitement radical d'emblée. A propos de 353 cas. Méd Chir Dig, 1993 ; 22 : 417.
  6. G.B. Cadière, J. Bruyns, J. Himpens, P. van Alphen. Vagotomie suprasélective par coelioscopie. J Coeliochir, 1993 ; 6 : 8 - 15.
  7. M. Amraoui, A. Bougtab, J. Ouadfel, M. Echarrab, M. Nouri, D. Touiti. Les perforations itératives de l'ulcère duodénal à propos de 5 cas. Lyon Chir, 1995 ; 91 : 369 - 371.
  8. G.F. Herbault, B. Benoix, E. Jean. Les facteurs de récidive des ulcères duodénaux perforés après suture simple. J Chir 1985 ; 122 : 675 - 980.
  9. B. Bustos, J.G. Balique, B. Payan, M. Chabert, J. Porcheron. Traitement de l'ulcère duodénal perforé : place de la coelioscopie. A propos de 31 cas. Lyon Chir, 1995 ; 91: 328 - 332.
  10. M.L. Druart. Résultats du traitement laparoscopique des ulcères gastro - duodénaux perforés : étude rétrospective multicentrique. Belgian group endoscopic surgery. Méd Chir Dig,1993 ; 22: 422.
  11. D. Mutter, P. Weber, V. Tassetti, P. Keller, M. Vix, S. Evrard. Evaluation de la coeliochirurgie dans le diagnostic et le traitement des péritonites aigues. In : 2é Congrès francophone de coeliochirurgie, J Pathol Dig 1994.
  12. D.B. MacGregor, L.E. Savage, C.B. Macvay. Vagotomy and drainage for elective treatment of peptic ulcers. Surg Gynecol Obstet, 1978 ; 146 : 349 - 352.
  13. F. Gomez-Ferrer. Gastrectomie linéaire antérieure et vagotomie tronculaire postérieure. J Coeliochir, 1992 ; 4 : 35 - 38.
  14. R.C. Frazee, J.W. Roberts, G.C. Okeson, R.E. Symmonds, S.K. Snyder, J.C. Hendricks. Open versus laparoscopic cholecystectomy : a comparison of post - operative pulmonary function. Ann Surg, 1991 ; 213 : 651 - 655.
  15. J. Perissat, D. Collet, M. Edyc. Therapeutic laparoscopy. Endoscopy, 1992 ; 24 : 138 -143.
  16. S.A. Raimes, H.B. Devlin. Perforated duodenal ulcer. Br J Surg ,1987 ; 74 : 81 - 82.
  17. D. Mutter, S. Evrard, P. Keller, M. Vix, S. Vartolomei, J. Marescaux. Traitement de l'ulcère duodénal perforé: la voie d'abord coelioscopique. Ann Chir, 1994 ; 48 : 339 - 344.
  18. G.B. Cadière, J. Bruyns, R. Verroken, D. Dubail, J. Himpens. Traitement Laparoscopique des ulcers gastroduodénaux perforés. J Pathol Dig, 1994 ; 4 : 55 - 71.
  19. M. Matsuda, M. Nishiyama, T. Hanai, S. Saeki, T. Watanabe. Laparoscopic omental patch repair for perforated ulcer. Ann Surg, 1995 ; 221 : 236 - 240
  20. T.V. Taylor, A.A.Guny, D.A.D. MacLeod, T.L.M.V. van Vroon Moven, P.D. Bornman, J. Terblanche. Mortality and morbidity after anterior lesser curve seromyotomy with posterior truncal vagotomy for duodenal ulcer. Ann Chir, 1985 ; 72 : 950 - 951.