Open versus laparoscopic repair of perforated duodenal ulcer: a comparative study

Background: Surgery is the mainstay of the treatment for perforated duodenal ulcer by closing the perforation with or without omental patch. There are no controversies in the surgical treatment of perforated duodenal ulcer but the best approach to surgery is still debatable. Advances in minimal access surgery has made it possible to close the perforated duodenal ulcer laparoscopically. The present study was conducted to compare the results of open and laparoscopic repair of perforated duodenal ulcer in terms of operative time, postoperative pain, hospital stay, and post-operative complications etc.Methods: The study was conducted in Dr. V. M. Government Medical College and Hospital located in Solapur (Maharashtra) from December 2008 to December 2010. It was a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Most commonly affected age in this study was 51 to 60 years with male preponderance. Post-operative pain, analgesic requirement, wound infection, hospital stay, was significantly less in laparoscopic group as compared to open group (p<0.05).Conclusions: Laparoscopic repair of perforated duodenal ulcer is safe and feasible in properly selected patients and has superior results as compared to open surgery.

Abordaje laparoscópico de úlcera gástrica perforada / Laparoscopic treatment of perforated gastric ulcer

Antecedentes: La reparación de una úlcera péptica perforada puede efectuarse con un simple cierre con sutura o con parche de epiplón (Graham) suturado o grapado. El cierre primario más parche de Graham se ha convertido en el método predilecto de un sinnúmero de instituciones. Aparentemente, el tratamiento urgente por vía laparoscópica es bastante efectivo y goza de tasas aceptables de morbilidad y mortalidad comparado con la cirugía convencional. Caso clínico: Se presenta el caso clínico de un paciente varón de 66 años de edad, el cual presenta antecedentes de HAS y AR sin tratamiento, fue llevado al servicio de urgencia del hospital General "Dr. Gonzalo Castañeda" del ISSSTE con un cuadro de 12 h de evolución caracterizado por dolor en epigastrio de tipo ardoroso, inicio súbito, intenso, el cual se generalizó posteriormente a todo el abdomen, presentado datos de respuesta inflamatoria sistémica y mal estado general, abdomen con irritación peritoneal y abdomen en madera, leucocitosis y aire libre subdiafragmático en placa simple de tórax, por lo que diagnosticó ulcera péptica perforada y se decidió realizar cirugía de urgencias. Se utilizó reparación laparoscópica de ulcera gástrica perforada con colocación de parche de epiplón y lavado de cavidad peritoneal con evolución satisfactoria del paciente y posterior egreso de éste. Con el advenimiento de las técnicas laparoscópicas, la factibilidad y seguridad del cierre laparoscópico de las úlceras pépticas perforadas ha sido demostrada en algunas series publicadas recientemente. Conclusión: es evidente que la reparación laparoscópica de úlceras pépticas perforadas puede ser considerada como un método seguro y efectivo, particularmente en pacientes con menos de 24 h de evolución, contando además con algunas de las ventajas ya establecidas de las técnicas mínimamente invasivas.

Background: The repairment of perforated peptic ulcer can be done with a simple suture closure with omental patch (Graham) stitches. Primary closure plus Graham patch has become the preferred method of many institutions. Apparently, the laparoscopic emergency treatment is quite effective, enjoying acceptable rates of morbidity and mortality compared with conventional surgery. Clinical case: We report a case of male patient aged 66 who has a history of SAH and AR without treatment, is brought to the emergency service of General Hospital "Dr. Gonzalo Castañeda "ISSSTE with 12 hrs of evolution presenting epigastric pain of sudden onset of intense burning rate which subsequently generalize to the entire abdomen, reported data of systemic inflammatory response and poor general health, abdomen with peritoneal irritation and wood abdomen, leukocytosis, and subdiaphragmatic air on simple chest plate, diagnosed as perforated peptic ulcer and emergency surgery say using laparoscopic repair of perforated gastric ulcer with omental patch placement and washing of peritoneal cavity of the patient with satisfactory outcome and completion of he. With the advent of laparoscopic techniques, the feasibility and safety of laparoscopic closure of perforated peptic ulcers has been demonstrated in some studies published recently. Conclusion: it is clear that the laparoscopic repair of perforated peptic ulcer can be considered as a safe and effective, particularly in patients with less than 24 hrs of evolution, and also boasts some of the already established advantages of minimally invasive techniques.

Comparing the clinical efficacy between laparoscopic and open omental patch repair for perforated peptic ulcer / 中国医师进修杂志

Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower postoperative pain at 3 d[(2.8 ±1.5) scores], earlier time to first flatus [ (25.8 ± 20.1) h] and resumption of diet [ (2.7 ±2.1) d ], shorter time to drainage removal [(2.0±1.5) d], less wound infection (0) and shorter hospital stay[(4.8 ±2.3) d] than those in OR group [(53.2±30.0) ml, (36.9±27.9) h, (3.7±2.0) scores, (3.6±2.3) d,(2.9±2.2) d,9.4%(5/53), (6.6±4.0) d](P< 0.01 or <0.05). There were no significant differences in operative time,postoperative pain at 1 d, incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of less postoperative pain,earlier return of bowel function,less wound infection and shorter hospital stay.