A novel combined laparoscopic-endoscopic overstitch technique for pediatric gastric ulcer perforation: an innovative approach to repair of hollow viscus perforations

We report the first pediatric use of a laparoscopic-assisted endoscopic overstitch technique for managing an acutely perforated gastric ulcer in a 16-year-old female. The patient presented with symptoms consistent with gastrointestinal perforation, confirmed by radiologic pneumoperitoneum. Diagnostic laparoscopy identified inflammatory adhesions and a gastric ulcer perforation. Concurrent endoscopy precisely located the defect, which was effectively closed using an endoscopic overstitch device mounted on a therapeutic double-channel gastroscope. Closure involved three full-thickness inverted figure-of-eight sutures, verified by an intraoperative leak test and reinforced with an omental patch. Postoperative recovery was rapid and uncomplicated, progressing to a regular diet within 3 days. This innovative hybrid laparoscopic-endoscopic technique demonstrates efficacy, safety, and the benefits of minimally invasive surgery for pediatric gastrointestinal perforations, emphasizing its potential superiority over traditional methods.