Observational study of laparoscopic closure of peptic ulcer perforation in rural population

Sudhir B. Deshmukh; Kuldeep Sharma; Meghraj J. Chawada

doi:10.18203/2349-2902.isj20161486

Authors

Sudhir B. Deshmukh Professor and HOD, Department of General Surgery, S. R. T. R. Government Medical College, Ambejogai, Maharashtra
Kuldeep Sharma PG Student, Department of General Surgery, S. R. T. R. Government Medical College, Ambejogai, Maharashtra
Meghraj J. Chawada Associate Professor, Department of General Surgery, S. R. T. R. Government Medical College, Ambejogai, Maharashtra

DOI:

https://doi.org/10.18203/2349-2902.isj20161486

Keywords:

Peptic ulcer, VAS, Hospital stay

Abstract

Background:Peptic ulcer perforation is one of the common surgical emergencies which need immediate surgical intervention. For many years, the routine upper laparotomy still seems to be the routine treatment of perforated peptic ulcer. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery. Objective of the study was to assess the efficacy of laparoscopic approach in perforated peptic ulcer repair.

Methods: The present study is based on the analysis of 30 cases of peptic ulcer perforation admitted to our hospital between 2013 and 2015. Post-operative mobilization of every patient was done after 6 hours and H₂ receptor antagonist or proton pump inhibitor was given with fluid, antibiotics and nasogastric suction. Post-operation analgesics (IV tramadol ± IM diclofenac SOS) were given according to visual analogue score (VAS).

Results:22 (73.33%) patients were having duodenal ulcer perforation and 8 (26.67%) were having gastric ulcer perforation. Postoperatively out of 30 patients, 18 patients were presented with VAS 4. The most common complication was trocar site infection seen in 2 patients (6.6%). 3 patients (10%) needed to covert laparoscopic procedure into open procedure due to large size of perforation (>10 mm). The hospital stay varied from 4-16 days.

Conclusions:Laparoscopic repair of perforated peptic ulcer is safe and reliable technique. It gives the patient all the advantages of laparoscopic surgery with accepted post-operative morbidity and mortality rates. However, laparoscopic closure of the perforation is technically demanding. It should be considered as a good choice in the presence of reasonable laparoscopic skills and experience. It had less postoperative pain and reduced analgesic usages, shorter postoperative hospital stay and early return to oral feeding and normal daily activities.