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Single Incision Laparoscopic Peptic Ulcer Repair with the Use Extracorporeal Mishra Knot: A Case Report.

Ross O Downes

Background: Single-port laparoscopic surgery is increasingly being used in cases of complex and complicated laparoscopic surgical intervention. We present a case of the cost effective Mishra’s extracorporeal knotting approach for treatment of a perforated duodenal ulcer (PUD). Methods: We present a case report of a patient with perforated duodenal ulcer who underwent single-port laparoscopic repair. She had peritoneal lavage and suture of the perforation using the Mishra’s knot. This was reinforced with an omental patch repair. After surgery, the patient was placed on an indefinite course of proton pump inhibitors. Results: We successfully completed the procedure via SILS (single incision laparoscopic surgery). We subsequently placed a drain in the right lower quadrant. The operative time was 57 min, and hospital stay was 5 days. She had minimal analgesic requirements. There was no operation-related morbidity. Follow-up to 6 months was done. Conclusions: Single-port laparoscopic repair using the Mishra knot technique is a feasible and safe Procedure. It is a cost technique for Single incision laparoscopic surgery (SILS) treatment of perforated duodenal ulcers.