Open Versus Laparoscopic Primary Closure of Perforated Peptic Ulcer

ABSTRACT

PURPOSE: To compare short-term clinical outcome of laparoscopic primary closure and open primary closure for the treatment of perforated peptic ulcers. METHODS: A prospective non-randomized study was perfor med for patients with perforated peptic ulcer at the Ewha Womans University Mokdong Hospital between Janunary 1999 and August 2001. Fifteen patients (Group L) underwent a laparoscopic primary closure by a modified Graham's method. The control group (Group O) was comprised of twenty patients who underwent a conventional open primary closure by a modified Graham's method. Statistical comparisons were made by a two-tailed Student's t-test. RESULTS: The group L and O were comparable for age, weight, preoperative leucocyte count, Blood urea nitrogen creatinine, and associated medical illness. Significant differences (P<0.05) were present between the groups with regard to the mean operative time (118.7 vs 80.8 minutes) and time to nonfebrile conversion following the operations (postoperative 2.2 days vs. postoperative 3.1 days). There were no differences in blood loss, frequencies of pain control, recovery of bowel movement, and postoperative hospital stay. Complications were seen in 1 of the cases in group L (pleural effusion), and 2 in group O (upper gastrointestinal bleeding, wound dehiscence). There was one case of mortality, due to septic shock, in group O. CONCLUSION: Laparoscopic primary repair could be a safe and feasible technique for the treatment of peptic ulcer perforations with a cosmetic advantage and faster recovery.