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PubMed2005

Cutaneous perforators of the upper arm and clinical applications.

The authors investigated the distribution of constant cutaneous perforators in the upper arm. A total of 20 amputated upper arms of 10 fresh Korean cadavers were used for the study. Red latex was injected into the axillary arteries of ten specimens and lead oxide-gelatin mixture (radiopaque material) in the other ten. The cutaneous perforators were then identified by dissection and radiography. The upper arm had several (range: 5.7 to 6.3) perforating arteries in the subfascial plane, but only four fasciocutaneous perforators were constant: one in the medial intermuscular septum and three in the lateral intermuscular septum. The constant medial perforators were included in a circle of 2.89 cm in diameter, the center of which was 8.9 cm above and 1.2 cm medial to the medial epicondyle. The mean length and diameter of the extended pedicle of the medial perforator was 2.78 cm and 0.94 mm, respectively. The lowermost constant lateral perforators were included in a circle of 2.44 cm in diameter, the center of which was 16.8 cm above and 0.5 cm medial to the lateral epicondyle. The mean length and diameter of the extended pedicle of the lateral perforator was 2.88 cm and 0.84 mm, respectively. A flap based on the perforator of the medial intermuscular septum is not as simple as with the lateral intermuscular perforator, but direct closure of the donor site is more favorable. It is safe to design a free skin flap with knowledge of its dominant perforator.

Arm↗
PubMed1992

[Perforation of surgical gloves in gynecologic operations and abdominal Cesarean section].

The aim of the study was to determine the incidence of glove perforation during gynaecological operations and Caesarean section, and to assess the value of double gloving. For this purpose the surgical gloves used in 415 procedures were tested for perforations by the water leak test. For laparotomy and breast surgery, two pairs of gloves (brand A) were worn; for vaginal and other surgery, only a single pair of thicker gloves (brand B) was used. As controls, 75 pairs of unused gloves of each brand were tested. This revealed 6 (4%) perforations in brand A gloves and 2 (1.3%) perforations in brand B gloves. Most perforations (20-40%) occurred during hysterectomy, Caesarean section, and other types of laparotomy. The gloves worn by the scrub nurse or technician were most often perforated (43.5% after vaginal hysterectomy), followed by the surgeon's gloves (29% after laparotomy). Perforations were most often located at the tip of the index finger (16.8%) and thumb (16.2%) of the nondominant hand. If two pairs of gloves were worn, and perforation occurred, only 26.7% had perforations at identical sites on the outer and inner gloves. Consequently, since three quarters of the perforations were limited to the outer glove, double gloving reduced the risk of exposure to blood by a factor of 4. The results of this study support the recommendation that two pairs of gloves be worn, at least during major surgical procedures and Caesarean section. Furthermore, the alternative operative techniques and methods of handling surgical instruments proposed for reducing the incidence of glove perforation should be tested.

Cesarean Section↗
PubMed2002

Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases.

The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue defect reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients in Chang Gung Memorial Hospital. A total of 439 flaps were cutaneous or fasciocutaneous flaps based on musculocutaneous perforators. The analysis of the flap failures was done only in this perforator series. In six cases, no suitable skin vessel was found during the dissection of the flaps. The complete success rate was 96.58 percent (424 of 439). Of the 15 failure cases, eight were complete and seven were partial (10 percent to 60 percent of the flap). Thirty-four flaps were reexplored, and 19 (56 percent) were salvaged. In this study, some of the reasons for the flap failure, unique to the anterolateral thigh perforator flap, were identified. They include inadvertent division of perforator at the fascial plane as a result of inadequate knowledge of perforator anatomy, inadvertent injury to the perforator during intramuscular dissection (noted by the surgeon or ignored) as a result of inexperience, and twisting of the pedicle during inset of the flap at the recipient site. Technical pearls in the harvest of the anterolateral thigh perforator flap are as follows: mapping of the skin vessels with a Doppler probe before flap design, meticulous dissection of the perforator under surgical loupe or even lower-magnification microscope, inclusion of a small fascia cuff around the perforator, and intermittent topical use of Xylocaine during the intramuscular dissection of the perforators. During reexploration, one must search for twisting of the pedicle and small bleeders from the branches of the intramuscular perforators.

Adolescent↗
PubMed2002

Needle perforations of Molteno tubes.

PURPOSE: To investigate the effects of needle perforation of proximal Molteno tubes on intraluminal pressure in a constant flow system. MATERIALS AND METHODS: Balanced salt solution was infused at a rate of 2 microL/min through nonexpansile silicon tubing attached to a manometric reservoir, pressure transducer, and an occluded proximal Molteno glaucoma drainage device tube. As the intraluminal pressure rose to approximately 30 mm Hg, the tube was perforated once with needles ranging in size from 23G to 29.5 G (disposable insulin syringe). Intraluminal pressure was measured continuously throughout each test run for an average of 71 minutes each. RESULTS: The average stable intraluminal pressure ranged from 25 mm Hg for 29.5-G perforation to 15 mm Hg for 23-G perforation. The lowest single pressure recorded ranged from 3 mm Hg for 23-G perforations to 17 mm Hg for 29.5-G perforations. Pressures of less than 15 mm Hg were recorded in more than 60% of the 23-G and 25-G perforations, less than 20% of the 27-G perforations, and none of the 29.5-G perforations. CONCLUSION: At a flow rate of 2 microL/min of balanced salt solution, 23-G and 25-G needle perforations of silicone glaucoma drainage device tubes produce intraluminal pressures in vitro, which may result in low intraocular pressures. Immediate postoperative hypotony risk can be reduced if a smaller needle perforation is used.

Molteno Implants↗
PubMed2005

Biceps femoris perforator free flap for upper extremity reconstruction: anatomical study and clinical series.

BACKGROUND: Perforator flaps are an important development in reconstructive surgery. The description of new perforator flaps is an open field in anatomical and surgical research. METHODS: The anatomy of the musculocutaneous perforating vessels of the short head of the biceps femoris muscle was investigated as a possible source for free tissue transfer in 10 fresh specimens. A series of 10 free biceps femoris perforator flaps for upper extremity reconstruction is described. RESULTS: There were three constant sizable perforators, located at 6 cm (range, 5 to 6.5 cm), 11.6 cm (range, 10 to 14 cm), and 15.3 cm (range, 14 to 17 cm), respectively, from the knee joint line. The distalmost perforator was a branch off the superior lateral genicular artery in all anatomical specimens. The middle perforator was a direct branch off the popliteal artery in 60 percent of the cases and off the profunda femoris in the remaining 40 percent. The uppermost perforator was usually a branch off the middle perforator. The flaps of the clinical series were based on the middle perforator (11.6 cm). All 10 free flaps were used for upper extremity trauma coverage, with a 100 percent success rate, although one flap required pedicle revision because of arterial thrombosis and developed partial necrosis. Donor-site delayed wound healing occurred in two patients. CONCLUSIONS: The vascular anatomy is relatively constant. Flap dissection is straightforward under tourniquet control, donor morbidity is low provided a primary closure is possible, and pedicle size is appropriate for repair. When a moderate-size free flap with moderate thickness and a medium-sized pedicle is needed, the biceps femoris perforator flap should be considered in the first-choice group of donor areas.

Adolescent↗
PubMed2006

New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications.

BACKGROUND: Many studies have revealed facts about the anatomy of the medial sural artery perforator. The exact locations or areas where the perforators pierce through the fascia, however, have not been clearly identified. METHODS: Based on cadaver dissections performed on 40 legs from 20 cadavers, the authors identified the location of the first and second perforators of the medial sural artery. The passages of the medial sural artery perforators were also confirmed by means of duplex-Doppler scanning, three-dimensional computed tomography, and angiography. RESULTS: The authors found that the main perforators of the medial sural artery were located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. The hip joint was flexed in supine position and the knee joint was flexed into a 90-degree angle, thus making it possible to observe the first perforator, which was approximately 8 cm from the midpoint of the popliteal crease, and the second perforator, which was approximately 15 cm from the popliteal crease. A series of 21 clinical cases with soft-tissue defects were successfully treated using the medial sural artery perforator flap, including 18 free flaps and three pedicled flaps. There were seven cases of hand reconstruction and 14 cases of lower extremity reconstruction. CONCLUSIONS: Until now, it has been a general belief that the exact location of a perforator cannot be predicted. The authors, however, have found that the first perforator was located almost 8 cm from the midpoint of the popliteal crease within the distal half circle drawn with a radius of 2 cm. Because this study made it possible to prepare a diagram of the exact location of the medial sural perforators, it is expected that more professionals will use this method for hand and facial reconstructions in the future.

Adolescent↗
PubMed2004

Glove perforation in outpatient dermatologic surgery.

BACKGROUND: Intact surgical gloves ensure protection of health-care employees and health-care recipients. Nevertheless, glove perforation is very common and puncture rates above 50% have been published in the literature. OBJECTIVE: It was our aim to evaluate the perforation rate of surgical gloves in outpatient dermatologic surgery. METHODS: Six-hundred and sixty latex surgical gloves used in outpatient dermatologic surgery were evaluated for perforations using the approved water-leak method. Perforations were analyzed microscopically. RESULTS: Twenty of the 660 gloves were found to have perforations, which corresponds to a perforation rate of 3.0%. Only 5 of these perforations (25%) were noticed by the wearer. Perforations were more numerous in nondominant-handed gloves. Microscopically, all perforations could be identified as needle stick injuries. CONCLUSION: The risk of glove perforation in outpatient dermatologic surgery is lower than in many other medical specialties. The relatively high number of surgical procedures performed successively in outpatient dermatologic surgery, however, emphasizes the decisive relevance of an intact barrier between surgeon and patient. In view of the major fact that most perforations go unnoticed by the wearer, dermatologic surgeons must balance the improved safety of double gloving with costs and the loss of sensitivity and dexterity.

Accidents, Occupational↗
PubMed2006

Choroidal detachment in perforated corneal ulcers: frequency and management.

AIMS: To determine the frequency of choroidal detachment (CD) in eyes with non-traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations. METHODS: 18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non-traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B-scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed. RESULTS: Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2 mm2, six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of <or=2 mm2 (p = 0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and two failures (13%). Within the successes four patients (27%) required re-gluing because of infection (one patient) or progression of melt and glue loosening (three patients). Failure was the result of severe progression of melting (one patient) and a very large perforation (one patient). CONCLUSION: Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B-scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large may require drainage. Cyanoacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ.

Aged↗
PubMed1996

Risk factors of oesophageal perforation during pneumatic dilatation for achalasia.

BACKGROUND/AIMS: Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of cases. The aim of this retrospective survey was to identify predictive risk factors for perforation in a consecutive series of 218 patients with achalasia. METHODS: Between 1983 and 1993, 270 pneumatic dilatations were performed in 218 patients. A Witzel dilator was used in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations occurred (3%). The clinical, radiological, endoscopic, manometric, and technical data for the eight perforated patients were compared with those of 30 patients randomly sampled among those without perforation. RESULTS: All perforations occurred during the first dilatation. Perforations were fewer during dilatations with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%). Perforations were all located above the cardia, on the left side of the oesophagus. In a multivariate analysis, a small weight loss and a high amplitude of oesophageal contractions in the group of patients with perforations were predictive of complications (respectively, p = 0.001 and p = 0.026). A contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus was observed in three of eight patients with perforations but was not seen in any of the 30 patients without perforation (p < 0.01). CONCLUSIONS: This identification of risk factors should facilitate the choice between pneumatic dilatation or a surgical approach.

Aged↗
PubMed1991

[Effects of the perforation of the tympanic membrane on its vibration--with special reference to an experimental study by holographic interferometry].

Using canine temporal bone, perforations were surgically prepared at the anterior, inferior and posterior parts of the tympanic membrane, and the influences of these perforations on the tympanic vibration were observed and analyzed by holographic interferometry. Normal canine tympanic membrane had its respective single maximum amplitude points at its anterior and posterior parts at a frequency from the low compass to 2 kHz or so and showed a concentric circular vibration pattern centering mainly there around. At 3 and 4 kHz or so, the posterior and anterior parts began to show their respective sectional vibrations and with an increase in frequency, showed their further complicated multi-sectional vibrations. Resonance frequency was 1 or 2 kHz or so. The tympanic vibration following the preparation of perforations was as follows: 1) For the posterior perforation, the frequency at which the anterior sectional vibration began passed to a higher frequency, while for the other perforations, no change was noted in vibration pattern of the remaining tympanic membrane. 2) Comparative examination of the vibration amplitude at the mallear tip revealed that for a small perforation, no change in resonance frequency was noted regardless of the location of perforation and an increase in vibration amplitude was noted near the resonance frequency. 3) For the anterior perforation, no change in resonance frequency was noted even with an expansion of perforation and an increase in vibration amplitude was noted near the resonance frequency. 4) For the posterior and inferior perforations, the resonance frequency passed to a higher frequency with an expansion of perforation and an increase in vibration amplitude was noted near the resonance frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Color Doppler sonography of arteries associated with perforating veins.

BACKGROUND: It has been known for some time that perforating veins had associated perforating arteries. There has been no way to investigate these arteries preoperatively. The newer high resolution ultrasonic devices enable us to investigate these arteries. We are able to localize, determine the frequency, and measure the size of the arteries associated with perforating veins of the lower extremities. METHODS: All patients were studied in our clinical vascular laboratory. PATIENTS: 55 patients with different degrees of varicosities were studied. MEASURES: Each patient had their perforating veins and arteries investigated with a 7.5 MHz linear array transducer (Siemens, Type Elegra). RESULTS: 73% of the 233 perforating veins identified had an associated perforating artery. No preferred localization of the perforating veins was noted. The number of location did not correlate with the presence or absence of incompetence of the veins. The perforating arteries were located in close proximity to the perforating veins but did not go far into the subcutaneous fat. The maximum systolic velocity was 12+/-8 cm/sec. CONCLUSIONS: The preoperative detection of perforating arteries associated with perforating veins is possible using a color Doppler scanner. Their pathophysiological function and its relation to bleeding complications, wound healing and ulcer healing can be studied using this tool.

Adult↗
PubMed2003

Perforating veins - a parameter of recurrence of esophageal varices.

OBJECTIVE: To study the role of perforating veins in predicting the likelihood of esophageal variceal rupture and variceal recurrences. METHODS: In 70 patients with esophageal varices, a 20 MHz ultrasonographic transducer was used to image esophageal varices; the radius and perforating veins were calculated. Esophageal variceal pressure measurements were obtained by noninvasive pressure gauge. The relationship between the size of esophageal varices and the presence of perforating veins in the esophageal wall was studied using chi-square test; the patients were divided into two groups according to the presence of perforating veins, and the pressure in each group was compared by using Student's t test. In addition, the frequency of endoscopy sessions necessary for varix eradication, the dots of endoscopic variceal ligation and recurrence of esophageal varices within a year were also compared by the Mann-Whitney U test. RESULTS: The presence of perforating veins in the esophageal wall was significantly higher in patients with large radius of varices than in patients with small radius. The esophageal variceal pressure in patients with perforating veins was greater than that of patients without perforating veins (23+/- 4.5 vs 12+/-3.1 mmHg, p<0.05). The frequency of endoscopy sessions required for varix eradication and the dots of EVL in patients with perforating veins was greater than that in patients without perforating veins (3.25 +/- 0.50 vs. 2.11+/-.78; 25 +/-.50 vs. 18.56+/- 5.46 p<0.05). The recurrence of esophageal varices within a year was higher in patients with than in patients without perforating veins (75.93 vs. 18.75%, p<0.05). CONCLUSION: Perforating veins in the esophageal wall correlate with the recurrence of esophageal varices in patients with portal hypertension

Adult↗
PubMedDate not supplied

Repair of the perforated sinus membrane with a resorbable collagen membrane: a human study.

PURPOSE: The purpose of this study was to evaluate the results of the repair of perforated sinus membranes with resorbable collagen membrane. MATERIALS AND METHODS: A split-mouth design was followed. Twelve subjects requiring bilateral sinus grafting were included in the study; one site had been accidentally perforated during sinus augmentation and the other site had not been perforated. The perforated sites were repaired with a resorbable collagen membrane. Dental implants were placed during a second surgery, and biopsy samples were harvested from both sinuses during implant placement. New bone formation was measured for all sites. Implant survival was recorded at second-stage surgery. Panoramic radiographs were taken before and after sinus grafting and after implant placement. RESULTS: Nonperforated sites demonstrated significantly more bone formation (33.58% +/- 7.45%) than perforated sites (14.17% +/- 7.06%) (P < .0001). Perforated sites demonstrated significantly more soft tissue formation (63.58% +/- 12.96%) than nonperforated sites (48.5% +/- 12.57%) (P = .006). In nonperforated sites, residual graft particles had more of their surface in contact with bone (40.17% +/- 14.92%) than perforated sites (14.5% +/- 12.03%) (P < .0001). The implant survival rate at second-stage surgery was superior for nonperforated sites (100%) in comparison to perforated sites (69.56%) (P = .0028). DISCUSSION: This study suggested that repairing the perforated site of the sinus membrane with a resorbable collagen membrane may result in reduced bone formation and implant survival rate. A different technique and/or materials than those used in the current study may offer better results for the repair of the perforated sinus membrane. CONCLUSION: The study demonstrated that perforation and repair of the sinus membrane may compromise new bone formation and implant survival.

Absorbable Implants↗
PubMed2004

Perforating veins of the shin in human foetuses.

There are 3 groups of perforating veins of the shin: the medial, the lateral and the internal sural perforating veins. Dysfunction of these veins is one of the main factors in venous hypertension. There is a lack of data in the literature concerning perforating veins of the shin in human foetuses. The aim of this study was identification of the perforating veins of the shin in human prenatal development. The material examined included 88 human lower limbs of foetuses (21 males and 23 females) aged from 16 to 38 weeks of intra-uterine life. The perforating veins were dissected under a steromicroscope. The number of perforating veins was analysed in relation to the sex of the foetus and the side of a body. In our study perforating veins of the shin did not show sexual or syntopic dimorphism. Between 2 and 6 Cockett's perforating veins were constantly present. Of these veins 80% divided into ascending and descending branches. Fibular perforating veins were found more often (90.9%) than Boyd's perforating veins (21.6%). Between 1 and 3 fibular perforating veins were observed but in 9% of cases they were entirely absent.

Dissection↗
PubMed2005

[Anatomy study of superior and inferior gluteal artery perforator flap].

OBJECTIVE: To find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue. METHODS: 5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area. RESULTS: Superior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx. CONCLUSIONS: The area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.

Adult↗
PubMed2006

Impact of the calf perforators on the venous hemodynamics in primary varicose veins.

The hemodynamic significance of the calf perforating veins continues to be the point of controversy. The conception that incompetent perforating veins cause hemodynamic disturbance and are responsible for the formation of leg ulceration has still many adherents prefering perforator surgery, whereas others reject any causal relation between large, incompetent perforators and severe forms of chronic venous insufficiency. In this study well documented facts concerning the impact of the calf perforators on the venous hemodynamics are reviewed. There is a bidirectional flow within calf perforators in healthy subjects enabling a quick equilibration of pressure changes produced during calf muscle contractions and relaxations, so that recordings of the mean pressure display identical values in superficial and deep veins of the lower leg, a feature typical of conjoined vessels. In cases with saphenous reflux, the bidirectional flow within calf perforators has a distinct inward vector directed to the deep veins; this inward component is the more pronounced, the larger the saphenous reflux is. Incompetent calf perforators do not cause ambulatory venous hypertension, exactly the opposite happens: the high hydrostatic pressure found in the quiet standing position drops significantly during ambulation, as soon as the saphenous reflux is interrupted. In primary varicose veins calf perforators can not become the source of reflux because they are situated at the lower pole of the ambulatory pressure gradient, which occurs between thigh and lower leg veins during ambulation. The size of the calf perforators is determined by the amount of saphenous reflux. When the saphenous reflux is abolished (e.g. by high ligation), the enlarged calf perforators diminish.

Chronic Disease↗
PubMed1991

Treatment of oesophageal perforation: a multivariate analysis.

Perforation of the oesophagus was retrospectively analysed in 59 patients. Cause and extent of perforation, localization, quality of the oesophageal wall and therapeutic modes were subjected to univariate analysis. The perforations of the intrathoracic oesophagus (39) were also subjected to multivariate analysis. Perforation of the cervical oesophagus is seldom lethal and can be adequately treated conservatively in the majority of cases. Perforations of the intrathoracic oesophagus can be divided into two groups, with or without simultaneous perforation of the parietal pleura. The optimal treatment for the group with pleural perforation seems to be resection of the oesophagus and secondary reconstruction, although primary closure is indicated in selected early cases. Perforations of the intrathoracic oesophagus confined to the mediastinum can be adequately treated conservatively in most patients. Perforation of the intra-abdominal oesophagus should be treated like any other intra-abdominal visceral perforation, by closure or diversion, even if this results in resection of the oesophagus.

Adolescent↗
PubMed1995

Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH)

We propose a novel technique for laparoscopic treatment of perforated gastroduodenal ulcers. The principle of this procedure involves the closure of the perforated ulcer using the ligamentum teres hepatis (LTH). The LTH is cut near its umbilical end and then dissected up to the site of its hepatic insertion. The umbilical extremity of LTH is grasped with a Dormia noose passed through the ulcerated perforation via a gastroscope. Using the noose, the LTH is pulled through the ulcerated perforation until its volume fits and completely closes the perforation. This laparoscopic technique was performed in 15 patients (12 M, 3 F) with anterior perforated duodenal ulcer revealed within the previous 6 h. The procedure could not be performed in three cases: diameter of the perforation exceeding 1.5 cm (n = 1), general purulent peritonitis (n = 2). In the other 12 cases, closure of the ulcerated perforation with the LTH was realized without technical difficulty. The postoperative course was uncomplicated. The posttreatment comfort was excellent; the mean period of hospitalization was 10 days (range, 8-14 days). An endoscopic examination carried out following 5 weeks of anti-H2 treatment showed that cicatrization of the ulcer was good and that no pyloric stenosis remained. These initial results suggest that laparoscopic treatment of perforated gastroduodenal ulcer using the LTH is a simple procedure which can be performed with general assurance of success in patients whose perforated ulcers have occurred quite recently. As the laparoscopic procedure is less aggressive than a laparotomy, it enhances the postoperative comfort of patients and prevents the risk of parietal complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗