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Introduction Timely diagnosis of the gastroduodenal perforation usually allows primary repair or resection. Treatment of a large gastric perforation is more difficult than the common duodenal ulcer perforation by plugging and usually requires agastric resection. On the other hand, gastric resection fora hemodynamically compromised patient in sepsis hasa high rate of anastomotic failure and mortality. Here, we described a practical surgical technique that can avoid emergency gastric resection in such situations. Presentation of case A 83 year-old female admitted with peritonitis, severe sepsis and hemodynamic instability. After the diagnosis of hollow organ perforation and supportive therapy, laparotomy revealed a delayed and large (7 cm) gastric perforation. Instead of gastrectomy, we downsized the large defect by means of a purse-string suture around the perforation and made it suitable for the application of omental plugging. Discussion The patients with poor performance status who are not suitable for the gastric resection, a free omental plug fixation to the narrowed perforation area by a purse-string suture can overcome the problem. Conclusion This method can be keep in mind as a damage control surgery technique in the non-traumatic abdominal emergencies due to large gastric perforations., Highlights • A new technique for damage control surgery. • Omental patching for gastric perforation. • Narrowing perforation area.

Purpose: Single-incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain and accelerated recovery. Although there have been reports of cholecystectomy and appendectomy using SILS, there have been few reports of gastric resection with intracorporeal reconstruction of the digestive tract using SILS. The first single-incision laparoscopic gastrectomy with intracorporeal reconstruction is reported. Methods: Preliminary experience with single-incision laparoscopic gastrectomy with intracorporeal reconstruction for a patient with an intractable gastric ulcer is reported. Results: Single-incision laparoscopy-assisted subtotal gastrectomy and Roux-en-Y reconstruction were performed. Operative time for gastrectomy and paraduodenal hernioplasty was 412 minutes, and blood loss was 90 g. No intraoperative or postoperative complications developed. Conclusions: Single-incision laparoscopy-assisted gastrectomy for intractable gastric ulcer is technically feasible. Intracorporeal reconstruction of the digestive tract was performed safely using a linear endoscopic stapler. This surgical approach is a further advance toward scarless surgery of the stomach., Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 22(4), pp.e210-e213; 2012

981 consecutive splenectomies at The New York Hospital were reviewed. 18.9% were removed incidental to some other procedure, either to facilitate exposure or because of uncontrolled bleeding from capsular tears. The primary operation with which this was most frequently associated was gastric resection for peptic ulcer disease, accounting for 20.5% of the spleens so removed. Conversely, the incidental splenectomy was noted in only 0.91% of all gastrectomies and 1.4% of all left colectomies designated as nonradical procedures. It is therefore seldom a necessary procedure. Incidental splenectomy is more frequent when midline abdoiminal incisions are employed, less frequent with paramedian or left rectus splitting incisions. 85% of the spleens removed incidentally were grossly and microscopically unremarkable; lacerations most probably result from excessive manipulation rather than pathological changes predisposing to rupture. The postoperative morbidity and mortality is discussed and is felt to be increased significantly by the incidental splenectomy.

The characteristics of 46 patients unable to take a solid diet within two weeks of gastric resection and had no other post-operative complications are reviewed. The incidence of delayed gastric emptying was found to be 2 1/2 times greater in patients with vagotomy and hemigastrectomy than in those with subtotal gastrectomy. In addition, postoperative delay was often prolonged in the hemigastrectomy and vagotomy group. Mechanical factors were responsible for delay in only 10% of these patients. Possible explanations for these delays are made and it is suggested that localized starch peritonitis may explain many cases of "functional efferent limb ileus." Measures to evaluate the source of delay are recommended and suggest conservative management for the majority of patients. Reoperation is reserved for those who require feeding or draining enterostomy tubes and those whose clinical course and evaluation suggest obstruction.

SUMMARY The fact that patients in whom chronic peptic ulcer develops have a psychobiologic lability above normal is well recognized. The reason for the unstable clinical status observed in this postoperative study is, therefore, not far to seek. There are many shades and nuances between the well group and the improved group, and also among the individuals comprising these groups. Most of the postoperative complications appear to occur within the first two years, but they may occur at any time later. Gastric resection is the best method available at present for the treatment of the complications of chronic peptic ulcer of the duodenum but is not ideal in that it is only relatively better than less extensive surgical procedures. This report is made in order to serve as a basis for future comparison and study, and it may be said to result from a search for a surgical procedure which combines in the highest degree both safety and efficacy.