Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

Authors

  • Vaibhav Srivastava 1Department of Surgery, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
  • Gyanendra Singh Department of Surgery, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
  • Santosh K. Singh Trauma Division, Department of Surgery, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180805

Keywords:

Laparoscopic repair, Open repair, Peptic ulcer perforation, Post-operative analgesia

Abstract

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.

Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.

Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).

Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

Metrics

Metrics Loading ...

References

Malkov IS, Zaynutdinov AM, Veliyev NA, Tagirov MR, Merrell RC. Laparoscopic and endoscopic management of perforated duodenal ulcers. J Am Coll Surg. 2004;198(3):352-5.

Crofts TJ, Park KGM, Steel RJC. A randomized trial of non-operative treatment for perforated peptic ulcer. N Engl J Med. 1989;320:970-3.

Siu WT, Leong HT, Law BK, Chau CH, Li AC, Fung KH, et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235(3):313-9.

McGuire HH, Horsley JS. Emergency operation for gastric duodenal ulcers in high-risk patients. Ann Surg. 1986;203:551-7.

Feliciano DV, Bitondo CG, Burch JM. Emergency management of perforated peptic ulcers in the elderly patients. Am J Surg. 1984;148:764-7.

Jordan GL, DeBakey ME, Duncan JM. Surgical management of perforated peptic ulcer. Ann Surg. 1974;179:628-33.

Wilson-Macdonald J, Mortensen NJ, Williamson RC. Perforated gastric ulcer. Postgrad Med J. 1985;61(713):217-20.

Collier D, Pain JA. Perforated peptic ulcers. J R Coll Surg Edinb. 1985;30:26-9.

Turner WT, Thompson WM, Thal ER. Perforated gastric ulcers. A plea for management by simple closure. Arch Surg. 1988;123:960-4.

Bornman PC, Theodorou NA, Jeffery PC. Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg. 1990;77:73-5.

Nicolau AE, Merlan V, Veste V, Micu B, Beuran M. Laparoscopic suture repair of perforated duodenal peptic ulcer for patients without risk factors. Chirurg. 2008;103(6):629-33.

Bertleff MJ, Halm JA, Bemelman WA, Van der Ham AC, Van der Harst E, Oei HI, et al. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg. 2009;33(7):1368-73.

Eypasch E, Spangenberger W, Ure B, Mennigen R, Troidl H. Laparoscopic and conventional suture of perforated peptic ulcers--a comparison. Chirurg. 1994;65(5):445-50.

Lunevicius R, Morkevicius M. Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg. 2005;92(10):1195-207.

Golash V. Ten-year retrospective comparative analysis of laparoscopic repair versus open closure of perforated. Oman Med J. 2008;23(4):241.

Seelig MH, Behr C, Zurmeyer EL, Schönleben K. Laparoscopic emergency surgery in perforated gastroduodenal ulcers. InKongressband. Deutsche Gesellschaft fur Chirurgie. Kongress. 2001;118:268-71.

Mehendale VG, Shenoy SN, Joshi AM, Chaudhari NC. Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study Indian J Gastroenterol. 2002;21(6):222-4.

Downloads

Published

2018-02-26

How to Cite

Srivastava, V., Singh, G., & Singh, S. K. (2018). Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery. International Surgery Journal, 5(3), 927–930. https://doi.org/10.18203/2349-2902.isj20180805

Issue

Section

Original Research Articles