Laparoscopic repair of perforated peptic ulcer
Sir
The surgical literature is currently flooded by numerous reports describing additional applications for non-invasive laparoscopic technology. Such is the observation of Messrs Walsh, Khoo and Motson ( B r J Sury 1993; 80: 127), who offer a novel approach to the laparoscopic treatment of perforated peptic ulcer. The authors perform laparoscopy to confirm or refute the diagnosis of perforation. If confirmed, the presence or absence of a naturally occurring omental patch is noted. If this is absent they convert to an open omentopexy procedure. If there is a naturally occurring omental plug, it is left alone and peritoneal lavage performed through one of the cannulas.
The authors correctly state that they 'see no merit in disturbing an omental patch already in place merely to spend a long time putting it back'. The existence of that naturally occurring omental plug and the notion that it should not be disturbed was described by Taylor and Warren] many years ago and applied in the conservative treatment of perforated ulcers. Accurate diagnosis of perforation does not require laparoscopic 'confirmation or refutation'. When spontaneous sealing of the perforation has occurred, as verified by a contrast study', most perforations are successfully treated without operation, i.e. without laparotomy, laparoscopic diagnosis or any form of peritoneal t ~i l e t ~. ~.