A team from Hong Kong, China, compared open with laparoscopic repair for perforated ulcers.
From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair.
A Gast-rografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation.
Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded. Thus, 121 patients (98 male, aged 16-89 years) entered the final analysis.
There were 9 conversions in the laparoscopic group to an open procedure, due to technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm.
Patients in the laparoscopic group required significantly less parenteral analgesics after surgery, than those who underwent open repair.
In addition, the visual analog pain scores on days 1 and 3 after surgery were significantly lower in the laparoscopic group.
Furthermore, laparoscopic repair required significantly less time to complete than open repair.
The researchers found that the median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group.
|Some benefits of laparoscopic over open repair:|
- Shorter operating time
- Less postoperative pain
- Reduced chest complications
| Annals of Surgery |
There were fewer chest infections in the laparoscopic group. However, there were 2 intra-abdominal collections in the laparoscopic group.
One patient in the laparoscopic group and 3 patients in the open group died after surgery.
Wing T. Siu, of the Pamela Youde Nethersole Eastern Hospital, Hong Kong, said on behalf of fellow authors, "Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure."
"It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair," it was concluded.