Repair Perforated DU

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Essential equipment:

  • Two 12mm & two 5mm trocars
  • Two Johan fenestrated forceps
  • Two needle holders
  • 5mm suction irrigation device
  • occasional a fan type retractor is required
  • NG Tube.

Stand on the patients left and approach as in cholecystectomy (port sites).  Perform a careful and complete lavage of the peritoneal cavity.  If the ulcer is sealed by the liver leave it alone until the above has been completed.  Expose the site of the perforation with the suction cannula.  Consider the diagnosis of malignancy.  Exercise judgement and convert if the perforation is not suitable to simple patch repair.  It ought to be an easy operation.

Close the perforation with 3 or 4 sutures placed 8mm from edge of perforation.  We use 2/0 Ethibond.  Never try to take a bite of both sides.  Tie the sutures as they are placed.  Finally overlay some omentum and suture in place.

Irrigate once more.  Leave a drain in the subhepatic space and pelvis.

Meta-analyses, Systemic reviews and randomised controlled trials

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