Abstract
Background: The goal of this study was to describe epidemiology and management strategies of the perforated peptic ulcer and the comparison of open and laparoscopic approach in the management of Perforated Peptic Ulcer. Perforated peptic ulcer (PPU), despite anti-ulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by
performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the dis-advantages such as prolonged surgery time and greater expense.
Methods: A retrospective study involved 45 patients with a clinical diagnosis of perforated peptic ulcer who 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. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score and length of post-operative hospital stay.
Results: 45 Patients diagnosed with perforated peptic ulcer were included; out of which 30 (66%) were male and 15 (33%) were female patients of ages ranging between35 to 60 years. The two groups were comparable in age, sex, site and size of perforations. Both the groups were subjected to open and laparoscopic repair randomly. 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.
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 returns to normal daily activities than the conventional open repair.