Laparoscopic surgery in acute perforated gastroduodenal ulcers: an underutilized technique despite favorable...

Acute perforation is a serious complication associated with peptic ulcer disease (PUD). Laparotomy remains the traditional operative intervention for repair. However, the laparoscopic approach has gained popularity over the last two decades. This study aims to evaluate the 30-day outcomes of laparoscopic and open approach in patients with acute PUD perforation.

Patients who presented emergently with acute gastroduodenal ulcer perforation between 2005 and 2017 were identified from the ACS-NSQIP database. Patients were stratified based on whether they underwent laparoscopic repair (LR) or open repair (OR) and selected using one-to-one propensity score matching (PSM). Primary outcomes included 30-day mortality, morbidity, readmission and reoperation rates, operative time, and total length of hospital stay (LOS). Categorical variables were assessed using Pearson's chi-squared or Fischer's exact tests. Continuous variables were tested with parametric or non-parametric tests.

7099 patients were identified; 775 (11%) underwent LR and 6324 (89%) underwent OR. 1534 patients were matched (767 patients per group); matched groups had similar demographic, comorbidity, and perioperative characteristics. There were no differences between LR and OR regarding 30-day mortality (5.6% vs. 6.9%, p = 0.292), overall morbidity (38.9% vs. 43.3%, p = 0.078), serious morbidity (36.1% vs. 37.3%, p = 0.634), and reoperation rate (5.5% vs. 6.5%, p = 0.454). LR had a lower 30-day readmission rate (6.5% vs. 7.3%, p = 0.002), lower overall minor morbidities (14.3% vs. 19.9%, p = 0.004), shorter median (IQR) LOS (6 [5,10] vs. 7 [5,11], p < 0.001). Median (IQR) operative time was longer in the LR group (83 [61, 109) vs. 63 [47, 86] minutes, p < 0.001).

LR of gastroduodenal ulcers is currently underutilized. Patients who underwent LR tended to have longer operative time, but shorter LOS, and lower readmission rates. There were no differences in 30-day mortality between LR and OR groups. Therefore, a laparoscopic approach should be attempted for patients presenting with acute perforation of gastroduodenal ulcers.