Background
Duodenal ulcer perforation is a surgical emergency that may lead to a risk for major morbidity and even mortality. Patient selection criteria are crucial to guide the surgeon in selecting the option of laparoscopic approach for patients with perforated duodenal ulcers. The purpose of this study was to compare the resulting outcomes for laparoscopic and open approaches for the repair of perforated duodenal ulcers.
Patients and methods
A total of 26 patients with perforated duodenal ulcers were included in this study, operated at Alain Hospital and Ain Shams University Hospitals, from June 2013 to June 2016. A total of 13 patients were operated by the laparoscopic approach and 13 patients were operated by the open approach. Follow-up indices such as mean operative time, hospitalization expense, and postoperative pain were included. The main outcomes were immediate surgical postoperative complications, fatalities, and reoperation. Secondary outcomes included operative time, postoperative pain, postoperative hospital stay, and time to resume diet.
Results
There were no major differences in the selected patients between these two procedures in main outcomes including overall surgical efficacy including surgical complication rate and surgery-related deaths. Further analysis of the surgical outcome revealed that laparoscopic repair had less surgical wound complication rate (wound infections and incisional hernias) compared with the open approach. Otherwise both approaches had almost similar rates of leakage, intra-abdominal collections, and ileus and thromboembolic complications. Regarding the secondary outcomes, it was notable that postoperative pain was much less, return to the regular diet was earlier, and hospital stay was decreased in the laparoscopic approach. This remarkable improvement of the secondary outcome attributed to overall patient satisfaction in the laparoscopic approach.
Conclusions
Laparoscopic approach is comparable with the open approach as a modality of repair for perforated peptic ulcer in the properly selected patients. The obvious advantages of laparoscopic surgery are the lower surgical site infection rates, early return to regular diet, shorter hospital stay, early return to work, less postoperative pain, better cosmetic outcome, and improved overall patient satisfaction. However, more studies should be undertaken to further assess the safety and efficacy of laparoscopic repair for peptic ulcer disease in the high risk patients’ category.