[Celioscopic treatment of perforations of duodenal ulcers. 6 cases]. / Traitement coelioscopique des perforations d'ulcère duodénal. 6 observations.

ABSTRACT

Traditionally, perforations of duodenal ulcers are managed by suturing followed by peritoneal lavage and the underlying cause is addressed secondarily. Laparoscopy provides a means of meeting the different therapeutic needs. From May to October 1993, we treated 6 consecutive perforations of duodenal ulcers laparoscopically. In 5 cases, the perforation was the first manifestation of acute duodenal ulceration and the other case was chronic. The laparoscopic operation included peritoneal lavage and simple suture of the ulcer. The immediate post-operative period was uneventful. With a current follow-up of 3.6 months, 5 patients are asymptomatic and ulcer cicatrization has been confirmed by fibroscopy. In the sixth case with a past history of chronic duodenal ulcer, re-operation was required after a delay of 2 months for acido-fundic vagotomy (performed laparoscopically). The local presentation was satisfactory in this patient. Extensive peritoneal lavage, which can be performed with laparoscopy together with suture when the ulcer is recent, allows managing such patients according to Taylor's method. The usefulness of vagotomy can then be addressed and performed later laparoscopically after the initial lavage. This new approach offers a means of complete cure and has all the advantages of the classical technique.