A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers

Although laparoscopic repair (LR) of perforated peptic ulcers (PPUs) has long been accepted, clinical evidence comparing LR versus open repair (OR) remains lacking. Consequently, this study compared the clinical outcomes and cost-effectiveness of LR versus OR.

From January 2010 to June 2014, 119 patients with PPU were divided randomly into LR (58 patients) and OR (61 patients) groups that were comparable in age, sex, smoking and drinking history, symptom duration, comorbidity, American Society of Anesthesiologists grade, Boey score, and white blood cell count.

The operative times for LR versus OR did not differ greatly (70 [interquartile range 60-90] vs 75 [60-90] minutes, respectively, P = .692), nor did postoperative complications. The LR group, however, required substantially less fentanyl than the OR group (0.74 ± 0.33 mg vs 1.04 ± 0.39 mg, P < .001). Moreover, the duration of hospital stay for the LR group was much shorter than those of the OR group (7 [5-9] vs 8 [7-10] days, respectively, P < .001). Although total hospital costs were similar (P = .465), the median intraoperative costs were greater for LR than for OR patients, at ¥6772 and ¥5626, respectively (P < .001). The median cost of ward stay tended to be ¥865 less in the LR group but was not statistically relevant.

LR and conventional OR are comparable in terms of operative duration and complications. The obvious advantage of LR is the greatly decreased hospital stay and less postoperative pain, at similar total hospital costs. Therefore, LR may be preferable for treating PPU in selected patients.