Laparoscopic Vs Open Closure of Duodenal Perforation
Journal Title: New Indian Journal of Surgery - Year 2017, Vol 8, Issue 2
Abstract
Introduction: Perforation is the second most common complication of peptic ulcer. Over 20% of the patients over the age of 60 years old presenting with perforated peptic ulcer are taking NSAID at the time of perforation. Perforated gastric ulcer results in a higher mortality rate than the perforated duodenal ulcer. Up to 80% of perforated duodenal ulcers are Helicobacter pylori positive. Treatment for perforated ulcer ranges from conservative treatment (Taylor’s approach) to radical surgery (vagotomy, gastrectomy). The surgical technique most often used is closure of the perforation combined with extensive peritoneal lavage. Repair of duodenal perforation by Graham patch placation represents an excellent alternative approach. Laparoscopic repair of duodenal perforation is a useful method for reducing hospital stay, complications and return to normal activity. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late incisional hernia. Aim and Objectives: Comparison between open closure of PPU and laparoscopic closure of PPU on the basis of day of the oral start of the feed, day of drain removal and pain score (VAS) on the 5th day. Material and Methods: The present prospective study was carried out in Dept. of surgery in Govt. Medical College and hospital, Aurangabad from December 2012 to November 2014. In this study, total 30 patients of perforated peptic (duodenal) ulcer with perforation peritonitis admitted was included after considering intra-operative confirmation of peptic (duodenal) perforation with exclusion and inclusion criteria. All 30 patients had first part duodenal ulcer perforation. Of total 30 patients, 15 patients were included in the laparoscopic (test) group and other 15 patients in open (control) group. Results: In the laparoscopic surgery group, the mean oral start of feed was on 2.64 days, while that in open surgery group was on 5.53 day. In the laparoscopic surgery group, the mean VAS score on day 5 was 1. 80, while that in open surgery group was 3.40. In the laparoscopic surgery group, the mean duration of hospital stay in days was 6.73, while that in open surgery group was 12.06. Conclusion: We concluded that, laparoscopic suture with omental patch repair is an attractive and superior alternative to conventional open surgery with extraordinary benefits of minimally invasive surgery.
Authors and Affiliations
Harbade Suresh
Keywords
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- EP ID EP471479
- DOI 10.21088/nijs.0976.4747.8217.20
- Views 74
- Downloads 0
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