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Published on: February 9, 2024
Minilaparotomy for perforated duodenal ulcer
Hideyuki Ishida1, Toru Ishiguro, Kensuke Kumamoto
1Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan. 05hishi@saitama-med.ac.jp
Abstract:
The usefulness of the minilaparotomy approach for perforated duodenal ulcer repair was retrospectively evaluated in 37 patients (26 men; mean age, 56.5 years). Simple closure with an omental patch by minilaparotomy (skin incision, < or = 7 cm) was successful in 86.5% of the cases, with an operative mortality of 2.7%. Compared with the results in historic control patients who underwent conventional open surgery (n = 27), a shorter operative time (P < 0.01), lower frequency of analgesic use (P = 0.03), earlier passage of flatus (P < 0.01), and shorter hospital stay (P = 0.04) were obtained in the patients undergoing minilapartomoy. The postoperative morbidity was identical between the two groups (16.2% versus 33.3%, P = 0.40). On multivariate analysis, a large amount of intraabdominal fluid was the only significant risk factor for extension of the minilaparotomy wound (P = 0.012). The minilaparotomy approach appears to be a feasible, safe, and less invasive approach compared with the conventional open approach and could be a useful alternative to the laparoscopic approach in selected patients with perforated duodenal ulcer.
Insights
Minilaparotomy repair for perforated duodenal ulcers is effective and safe, showing benefits over conventional open surgery. This less invasive approach offers advantages like shorter recovery times for selected patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Perforated duodenal ulcers present a significant surgical challenge.
- Conventional open surgery has associated risks and recovery times.
- Minimally invasive techniques are increasingly explored for abdominal emergencies.
Purpose of the Study:
- To evaluate the efficacy and safety of the minilaparotomy approach for perforated duodenal ulcer repair.
- To compare outcomes of minilaparotomy with conventional open surgery.
Main Methods:
- Retrospective evaluation of 37 patients undergoing minilaparotomy for perforated duodenal ulcer repair.
- Comparison with a historic control group (n=27) who had conventional open surgery.
- Analysis included operative time, analgesic use, flatus passage, hospital stay, and morbidity.
Main Results:
- Minilaparotomy achieved an 86.5% success rate with 2.7% operative mortality.
- Compared to open surgery, minilaparotomy resulted in shorter operative time, less analgesic use, earlier flatus passage, and shorter hospital stay.
- Postoperative morbidity was similar between groups; intra-abdominal fluid was a risk factor for wound extension.
Conclusions:
- Minilaparotomy is a feasible, safe, and less invasive option for perforated duodenal ulcer repair.
- It offers significant advantages over conventional open surgery.
- It represents a valuable alternative to laparoscopy in select patients.
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