Twelve years' progress in surgery for perforated gastric and duodenal ulcers: A retrospective study of indications for laparoscopic surgery, post-operative course and the influence of Candida infection

Background: Twelve years has passed since we introduced laparoscopic surgery for gastroduodenal perforation. Aim: To list problems and to investigate the feasibility of our clinical protocol for treatment of gastroduodenal ulcer perforation. Methods: Case records of 62 patients and histology samples of 9 patients undergoing surgery for gastroduodenal perforation were retrospectively reviewed. Results: Laparoscopic omental implantation is feasible for some cases of perforated peptic ulcer in patients who have either stenosis or massive perforations. In patients undergoing laparoscopic omental implantation, oral ingestion of water was started at 3.3 ± 0.5 post-operative days. Helicobacter pylori was positive in 27 of 35 patients (77%). Of 22 cases in whom intraoperative ascitic culture was taken, Candida was positive in nine (41%), and in six of eight cases involving wound infection or intraperitoneal abscess. Histological examination of resected stomach revealed the fungi with hypha formation at the base of the ulcer in 44% of patients. Conclusions: Laparoscopic omental implantation was more feasible than in the past. The possibility of Candida infection and subsequent abscess formation must be considered in patients with gastroduodenal ulcer perforation.