Laparoscopic Management of Perforated Peptic Ulcer: Multicenter Experience

Abstract

Background: Perforated peptic ulcer (PPU) is a common surgical emergency. Exploratory laparotomy and repair with the omental patch are routine surgical intervention till now. In developing counties, laparoscopic repair is still not considered the gold standard in this emergency condition. Objectives: This study was conducted to evaluate laparoscopic management of PPU in terms of peri-operative outcomes. Patients and methods: This prospective observational study included 151 patients who presented with PPU in three tertiary hospitals from February 2018 to February 2023. Patients were divided into two groups: group (L) included 75 patients who received laparoscopic management, and group (O) included 76 patients who received open management. Demographic and peri-operative data were collected tabulated and analysed. Results: No statistically significant difference between the studied groups regarding demographic and clinical data. The laparoscopic management group had statistically significant longer operative time (95±10.6 vs. 60±14.6 min.), lower doses of narcotic injections (1.564±0.432 vs. 5 ± 0.175), lower mean pain Visual Analogue Scale (VAS) (3±1 vs. 7±1), shorter time to resume oral feeding (2.1 ±.52 vs.3.4 ±.576 days), lower incidence of postoperative ileus, lower incidence of chest infection and wound infection, shorter hospital stay (5±1.54 vs. 8±1.6 days), shorter time to return to daily normal activities (12±2.9 vs. 24±3.4 days), and better satisfaction about cosmetic results. No statistically significant difference between the studied groups regarding postoperative leakage of the repair and incidence of intra-abdominal septic complications. Conclusion: Laparoscopic management of PPU has statistically significant better postoperative outcomes. It could be adopted as a standard technique in cases with small perforation, Boey’s score ≤ 1, and Mannheim Peritonitis Index ≤ 20.

Keywords

• laparoscopic repair
• open repair
• peptic ulcer
• perforation