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Laparoscopic Duodenal Perforation


  Duodenal perforation is a common complication of duodenal ulcer. Perforated duodenal ulcer is mainly a disease of young men but because of increasing smoking in women and use of NSAID in all the age group, now a days it is common in all adult population. In western society today it is a problem seen mainly in elderly women due to smoking alcohol and use of NSAID. Increased incidence in elderly is possibly due to increased NSAID use. 80% of perforated duodenal ulcers are H. pylori positive.
  Perforated duodenal ulcer is a surgical emergency. Laparoscopic repair of duodenal perforation is a useful method for reducing hospital stay, complications and return to normal activity. 
  Advantages of Laparoscopic Surgery :
  Cosmetically better outcome.
  Less tissue dissection and disruption of tissue planes
  Less pain postoperatively.
  Low intra-operatively and postoperative complications.
  Early return to work.
  Patient selection:
  Duodenal perforation is a laparoscopic emergency. If the patient condition is otherwise fit and peritonitis is diagnosed within 12 hours of onset. It is possible to repair the perforation by laparoscopic method. After 12 hour chemical peritonitis will give way to bacterial peritonitis with severe sepsis and then the laparoscopic repair is not advisable.

Anaesthesia: General Endotracheal Anaesthesia is used.

Patient may be discharged 2 days after operation if every things goes well. The patient may have slight pain initially but usually resolves. The patient having any complain should be examined endoscopically after 3 to 4 week of operation. The proton pump inhibitor should be prescribed routinely.
Laparoscopic repair of duodenal perforation is a useful method for reducing hospital stay, complications and return to normal activity if carried on in proper manner.

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