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Comparison between open and laparoscopic repair of perforated peptic ulcer disease
Ricky H Bhogal1, Ruvinder Athwal, Damien Durkin
1University Hospitals of North Staffordshire & Keele Medical School, 42 Clay Lane, Oldbury, Warley, West Midlands, B69 4SY, UK. balsin@hotmail.com
Insights
Laparoscopic repair of perforated peptic ulcers offers faster recovery and reduced pain compared to open surgery. This minimally invasive approach leads to shorter hospital stays and quicker return to normal diet and mobilization.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Laparoscopic repair of perforated peptic ulcer (PPU) with peritoneal toilet is established but not routine.
- Prospective study to compare laparoscopic versus open repair of PPU.
- Evaluation of early patient outcomes for laparoscopic repair versus conventional open repair.
Purpose of the Study:
- To compare the patient outcomes of laparoscopic repair versus open repair for perforated peptic ulcer disease.
- To assess if laparoscopic repair leads to improved early results and patient recovery.
Main Methods:
- Prospective study including all patients undergoing PPU repair over 12 months.
- Evaluation of primary endpoints: operative time, nasogastric tube use, IV fluid requirement, urinary catheter and drain usage duration, return to normal diet, opiate use, mobilization time, and hospital stay.
- Comparison between laparoscopic (n=19) and open repair (n=14) groups.
Main Results:
- No significant difference in total operative time between laparoscopic (61 min) and open (57 min) repairs.
- Laparoscopic repair showed significantly less opiate analgesia requirement (1.2 days vs 3.8 days), shorter nasogastric tube (2.1 vs 3.1 days), urinary catheter (2.3 vs 3.7 days), and drain usage (2.2 vs 3.8 days).
- Patients undergoing laparoscopic repair had reduced IV fluid needs (1.4 days vs 3.1 days), earlier return to normal diet (2.3 vs 4.8 days) and full mobilization (2.3 vs 3.3 days), and shorter hospital stay (3.1 vs 4.3 days).
Conclusions:
- Laparoscopic repair is a safe and effective surgical option for perforated peptic ulcer disease.
- This approach should be considered for all suitable patients, contingent on available surgical expertise.
- Laparoscopic repair offers significant advantages in postoperative recovery and resource utilization compared to open repair.
Background:
The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet has been established, although it is not routinely practiced. This prospective study compared laparoscopic and open repair of perforated peptic ulcer disease. We evaluated whether the early results from laparoscopic repair resulted in improved patient outcome compared with conventional open repair.
Methods:
All patients who underwent repair of perforated peptic ulcer disease during a 12-month period in our unit were included in the study. The primary end points that were evaluated were total operative time, nasogastric tube utilisation, intravenous fluid requirement, total time of urinary catheter and abdominal drainage usage, time taken to return to normal diet, intravenous/intramuscular opiate use, time to full mobilization, and total in-patient hospital stay.
Results:
Thirty-three patients underwent surgical repair of perforated peptic ulcer disease (19 laparoscopic repairs and 14 open repairs; mean age, 54.2 (range, 32-82) years). There was no increase in total operative time in patients who had undergone laparoscopic repair (mean: 61 minutes laparoscopic versus 57 minutes open). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (mean time to oral analgesia: 1.2 days laparoscopic versus 3.8 days open). In addition there was a significant decrease in the time that the nasogastric tube (mean: 2.1 days laparoscopic versus 3.1 days open), urinary catheter (mean: 2.3 days laparoscopic versus 3.7 days open) and abdominal drain (mean: 2.2 days laparoscopic versus 3.8 days open) were required during the postoperative period. Patients who had undergone laparoscopic repair required less intravenous fluids (mean: 1.4 days laparoscopic versus 3.1 days open) and returned to normal diet (mean: 2.3 days laparoscopic versus 4.8 days open) and full mobilization significantly earlier than those who had undergone open repair (mean: 2.3 days laparoscopic versus 3.3 days open). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (mean: 3.1 days laparoscopic versus 4.3 days open).
Conclusions:
Laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered for all patients, providing that the necessary expertise is available.
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