Role for laparoscopy in the management of perforated PUD and the indications for conversion to an open operation
The surgical goals in the laparoscopic management of a perforated peptic ulcer are similar to those of open surgical management:
- Repair of the perforation
- Copious irrigation of the abdominal cavity
- Addition of a definitive ulcer operation, which depends on the skill of the surgeon and may involve either laparoscopic truncal vagotomy and pyloroplasty or on rare occasion laparoscopic highly selective vagotomy
The relative indications for conversion to an open procedure include posterior location of the ulcer and inadequate localization.
The presence of a perforated gastric ulcer with its suspicion for malignancy may necessitate conversion for definitive diagnosis.
