Multimedia article: management of duodenal ulcer perforation with combined laparoscopic and endoscopic methods.

In the past, primary closes for perforated duodenal ulcer were not effective because of the high incidence of recurrence (42%), therefore most surgeons preferred definitive procedures to control acid production. Since the association of Helicobacter pylori with peptic ulcers and the effectiveness of the medication for acid control, definitive surgery is less frequently used. Today, primary closes of the perforation are the immediate alternative. Furthermore laparoscopic repair allows to perform the same technique than open surgery but with the benefits of the minimum invasion. The video shows the management of a 51-year-old woman who came to the emergency room with acute abdomen, leukocytosis, and fever. Laparoscopy showed peritonitis with apparent gastric perforation. Duodenal perforation was confirmed by endoscopy. Primary closes of the perforation, cavity cleaning, and placement of drainages were performed by laparoscopy. Evolution was excellent; the patient left the hospital 3 days after surgery. The contribution of laparoscopic and endoscopic surgery were shown to be highly beneficial for the patient, since an endoscopic view of the stomach and the duodenum was the pertinent approach to assure the correct perforation closes as well as to obtain diagnostic biopsy.