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Research Paper | Surgery | India | Volume 14 Issue 3, March 2025 | Popularity: 6.1 / 10
Is Two the Magic Number? Evaluating the Efficacy and Safety of Two-Stitch Laparoscopic Repair for Small Duodenal Perforations
Dr G Nitin Datta Yadav, Dr Rahul Kenawadekar
Abstract: Background: Duodenal ulcer (DU) perforations have historically been managed by several surgical techniques, including Graham?s patch, Cellan-Jones repair, or in complicated or recurrent cases definitive ulcer surgery (e.g., truncal vagotomy and pyloroplasty). The traditional Cellan-Jones repair for perforated duodenal ulcers involves placing three interrupted sutures reinforced with an omental patch. However, in small ulcers (?5 mm), placing multiple sutures may result in excessive tissue tension or suture overlap, potentially impairing healing. This study evaluated the outcomes of a simplified two-stitch laparoscopic repair for small duodenal perforations. Objective: To evaluate the efficacy, safety, postoperative leak rate, need for re-exploration, complications, 30-day mortality, and recurrence rates associated with two-stitch laparoscopic repair in patients with small duodenal perforations (?5 mm). Methods: This retrospective single-center cohort study analyzed 62 adult patients who underwent laparoscopic two-stitch repair of small duodenal perforations (?5 mm) between January 2014 and December 2023. Clinical data were gathered from operative reports, inpatient medical records, and outpatient follow-ups. The primary outcome was the efficacy and safety of two-stitch laparoscopic repair; secondary outcomes included postoperative leak rate, re-exploration, complications (e.g., wound infections or intra-abdominal collections), length of hospital stay, 30-day mortality, and recurrence at six-and twelve-month follow-up. Results: A total of 62 patients (mean age: 50.2 ? 13.1 years; range: 21?77 years) underwent laparoscopic two-stitch closure. The mean ulcer diameter was 3.0 ? 1.5 mm (range: 1?5 mm). All procedures were completed laparoscopically with no conversions to open surgery. No postoperative leaks, suture-line dehiscence, or mechanical failures necessitating re-exploration were observed. There were no major complications (e.g., wound infections or intra-abdominal abscess) and no 30-day mortality. The mean operative time was 62 ? 14 minutes, and the mean hospital stay was 4.6 ? 1.3 days. At six-and twelve-month follow-ups, no ulcer recurrence was detected at the original perforation site. Conclusion: This retrospective analysis indicates that a standardized two-stitch laparoscopic repair for small duodenal perforations (?5 mm) is highly effective, demonstrated by a zero postoperative leak rate and an absence of ulcer recurrence at one year. By avoiding suture overcrowding, the technique simplifies the surgical procedure while maintaining optimal healing conditions. Further prospective, multicenter investigations are warranted to validate these findings and refine suture strategies in the management of small duodenal perforations.
Keywords: Duodenal ulcer perforation, laparoscopic repair, two-stitch technique, omental patch, minimally invasive surgery
Edition: Volume 14 Issue 3, March 2025
Pages: 1105 - 1109
DOI: https://www.doi.org/10.21275/MR25325171126
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