Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Outcomes Research

Background:

• Perforated peptic ulcer (PPU) repair via laparoscopy is debated, especially for critically ill patients.
• Assessing the safety and efficacy of laparoscopic versus open surgical approaches for PPU is crucial.

Purpose of the Study:

• To compare the outcomes of laparoscopic repair versus traditional laparotomy for perforated peptic ulcer (PPU).

Main Methods:

• Retrospective analysis of 169 patients undergoing emergent PPU surgery between 2012 and 2019.
• Comparison of laparoscopic (n=49) and open laparotomy (n=120) groups, noting conversion rates and patient characteristics.

Main Results:

• Laparoscopy showed significantly fewer early postoperative complications (18.4% vs. 41.7%) and lower mortality (2.0% vs. 14.2%) compared to laparotomy.
• Patients undergoing laparoscopic repair experienced shorter hospital stays (median 6 vs. 7 days) and earlier oral intake (median 3 vs. 4 days).
• Laparoscopic approach was associated with patients without sepsis criteria, while open surgery had a higher prevalence of sepsis (38.3%).

Conclusions:

• Laparoscopic repair of PPU is a viable option for patients without sepsis, offering reduced complications and faster recovery.
• Further research is needed to establish the safety of laparoscopy for PPU treatment in patients with sepsis criteria.