Laparoscopic repair of perforated duodenal ulcers - The "three-stitch" Graham patch technique

Background: "Three-stitch" laparoscopic Graham patch repair (LGPR) for perforated duodenal ulcer enjoyed the same advantage as open Graham patch repair. However, it was not a popular approach because it had problems of suture entanglement and difficult laparoscopic suturing and knotting. The authors describe their technique and results. Methods: A prospective series from January 2000 to September 2004 was examined. In this study, 35 LGPRs were performed for 32 males and 3 females with a median age of 47 years (range, 18-76 years). Results: No conversion occurred for any of the 35 LGPRs attempted. The median perforation size was 5 min (3-10 mm), and the median operative time was 86 min (range, 55-163 min). The median time for ambulation was day 2, and the median time for discharge was day 4. Morbidity was 11%, involving one chest infection, one retention of urine, one pelvic collection, and one pyloric stenosis. There was no reoperation, leakage, or mortality. Conclusion: The authors' LGPR technique was safe and efficient, and might be the choice for laparoscopic repair of relatively large perforations.