This video is a step-by-step approach to the technique of laparoscopic repair of perforated peptic ulcer with omental patch. The operation was carried out on a 49 yr old male patient. He was admitted via our Accident & Emergency Department few hrs earlier.
He developed epigastric pain whilst at home the previous evening. His pain spread to the rest of his abdomen through the night. He had been fit & well with no history of indigestion and was not on any regular medications.
An erect chest X-ray on admission did not show free air under the diaphragm. A CT scan, however revealed both free air and fluid throughout his abdominal cavity. It was more prominent in the right upper quadrant though. The CT scan did not show the source of perforation.
Clinically, we suspected a perforated peptic ulcer and opted to undertake a diagnostic laparoscopy and proceed depending on the operative findings. The plan was fully discussed with the patient who consented to this course of action. Pre-operative resuscitation was instigated with intravenous fluids, antibiotics and proton pump inhibitor as well as adequate pain relief.
Post-operatively the patient made quick recovery. He was mobile from day one; the top drain was removed after 36 hrs, and the pelvic one after 48hrs. He was allowed diet from day two. He was advised to continue antibiotics and proton pump inhibitors for two weeks (triple therapy) with the latter for a further six weeks. He was discharged after three days with a plan to have a follow up gastroscopy two months later.

Esophagogastroduodenoscopy showing Duodenal Ulcer among other findings.
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