Laparoscopic Primary Closure: A Better Method of Treatment in Perforated Peptic Ulcer Disease than Open Repair

ABSTRACT

PURPOSE: Perforation is a dreadful complication of peptic ulcer disease requiring immediate management. This study examined the feasibility of laparoscopic primary closure in perforated peptic ulcer disease to allow an earlier return to normal life. METHODS: This study reviewed our experience retrospectively with 72 consecutive patients treated with the simple closure of a perforated peptic ulcer disease in our hospital from December 2002 to January 2011. Thirty five patients were treated laparoscopically and the rest underwent open surgery. The operative time, nasogastric tube utilization, abdominal drain usage, time to oral feeding, hospital stay, postoperative complications and recurrence in both groups were compared. A student's t-test was used to make the comparisons. A p value<0.05 was considered significant. RESULTS: The operative time, use of nasogastric tubes, and abdominal drainage were similar in both groups. After laparoscopic surgery, the patients showed an earlier return to normal oral feeding and discharge than the open surgery group (4.17+/-0.62 vs. 5.03+/-2.34 days, p=0.040, 8.63+/-1.96 vs. 10.24+/-3.59 days, p=0.021, respectively). The decreased handling of tissue in laparoscopic surgery led to less wound infection (0 in laparoscopic surgery vs. 3 in open) and postoperative ileus (0 vs. 2). CONCLUSION: Laparoscopic repair of a perforated peptic ulcer is a safe and feasible treatment that offers early oral feeding and a shorter postoperative hospital stay.