الفهرس 
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Abstract
Perforated peptic ulcer (PPU) is the most common indication for emergency upper gastrointestional surgery. Perforation occurs in about 2–10% of peptic ulcers and
of these about 60% is duodenal. The origins of PPU seem to be multifactorial, but most
are associated with (NSAIDs) and (H.P) infection. The vast majority of PPU patients
require emergency operation.
Prompt diagnosis of gastroduodenal perforation requires a high index of
suspicion based on history and clinical examination. Patients with gastroduodenal
perforation usually present with abdominal pain and peritoneal irritation from leakage
of acidic gastric contents. At physical examination pulse might be quickened. About 5-
10% of patients experience shock.
Imaging choices for diagnosing bowel perforations include plain films and
computed tomography. An upright chest x-ray is an excellent first choice. A positive
upright chest x-ray (free air beneath the diaphragm) can acutely make the diagnosis.
Laboratory studies are not useful in the acute setting as they tend to be nonspecific, but
leukocytosis, metabolic acidosis, and elevated serum amylase may be associated with
perforation.
Perforated peptic ulcer can be treated by using a wide range of options, which
varies from conservative non-operative treatment to immediate definitive ulcer surgery.
Acid reduction surgery is now being replaced by simpler procedures, such as
primary closure of the perforation, owing to better understanding of the
pathophysiology of peptic ulcer diseases and the improvement in anti-ulcer medications
Simple closure remains an attractive option for perforated duodenal ulcer in most
centers and hence the laparoscope is gradually gaining popularity to treat perforated
duodenal ulcer.
Nathanson et al. and Mouret et al. reported laparoscopic treatments of perforated
peptic ulcer in 1990 for the first time. Following these reports, perforated peptic ulcer
treatment by laparoscopy has gained popularity. There have been several reports of
successful laparoscopic repairs of perforated peptic ulcers, because laparoscopy provides
a better vision of the peritoneal cavity and avoids an unnecessary laparotomy, allowing
for the repair of the perforation and adequate peritoneal lavage without a large upperabdominal
incision. Furthermore, the procedure has been reported to have less
postoperative pain, the opportunity for early mobilization, and a reduction of
postoperative complications.
Some concerns about a longer operation time, and leakage. These disadvantages
of laparoscopic treatment can likely be attributed to the facts that the surgeons have less
experience in laparoscopic repair.
This study included 50 patient with PDU of Boey’s score 0 and 1 all patients
were subjected to detailed history, thorough general and local physical
examination, all patients were subjected to laboratory and radiographic evaluation,
divided in two groups one for laparoscopic repair the other for open repair by Graham
patch, 4 patient were converted to laparotomy, data collected and analyzed to show
implication of H.Pylori and NSAIDs in the pathology of perforation, significant longer
operation time in laparoscopic group but it has better recovery, less postoperative pain,
less morbidity, less pulmonary complication, less wound infection, shorter hospital stay
and earlier return to normal activity with no difference in leak or abscess formation
All patients received anti H.P drugs and had followed up to ensure healing of the ulcer.