Both gastric and duodenal ulcer perforations can be managed by laparoscopic oversewing. In the case of gastric ulcers, biopsy to exclude malignancy is necessary first.
Under general anaesthesia, the laparoscope is used to visually identify the hole and turbid, leaked fluid in sites such as the subhepatic pouch and paracolic gutters. Irrigation is used to disperse this fluid; aspiration follows.
A retractor placed down a cannula in the right subcostal region is used to retract the liver. Similar cannulae in the left and right upper quadrants are used for instruments to grasp and suture. As with the open approach, an omental patch is fixed over the hole with 2-3 externally knotted sutures. Tissue glue - a fibrous tissue spray - can also be applied to the site to improve the strength of the union.
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