Laparoscopic Repair of Perforated Peptic Ulcer.

The recent introduction of laparoscopy into the armamentarium of the general surgeon has revolutionized many aspects of surgical practice. The repair of perforated peptic ulceration is ideally suited to a laparoscopic approach. An accurate diagnosis is obtained, and closure of the perforation with thorough peritoneal toilet safely can be undertaken. The main advantages include the avoidance of a major incision and the reduction of postoperative pain. This may benefit the patient with associated respiratory disease in particular. Although mobilization may be improved, early discharge from the hospital is unlikely because the patient must recover from the peritonitis and associated ileus. The main drawback is a longer operating time caused by technical difficulty with laparoscopic suturing. Many innovative techniques have been described to simplify the procedure. The reported experience with laparoscopic repair of perforated peptic ulcers is encouraging, and randomized trials comparing it with open surgery are eagerly awaited.