Comparison of results of open versus laparoscopic repair for perforated peptic ulcer
Journal Title: Medpulse International Journal of Surgery - Year 2018, Vol 5, Issue 3
Abstract
Background: Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. Objective: To compare the results of open versus laparoscopic repair for perforated peptic ulcers. Methods: From January 2014 to June 2017, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gastrografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complication and deaths, and the date of return to normal daily activities. Results: Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine con-versions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intra abdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. Conclusions: Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to nor-mal daily activities than the conventional open repair. Peptic ulcer perforation is a common surgical emergency and a major cause of death in elderly patients.1,2 There is, however, disagreement as to the relative merits of non operative treatment, simple closure, or a definitive acid-reduction procedure for perforated peptic ulcers. Non operative treatment of perforated peptic ulcers was shown to be effective.3 However, the uncertainty in diagnosis, the potential delay for treatment in non responders, and the unreliable response in elderly patients make it difficult to be applied to all clinical situations.
Authors and Affiliations
Suresh Naik, Shivmurti Khandalkar, Firoz Alam, Ashwini Panditrao
Keywords
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