Laparoscopy: A Better Approach for Perforated Duodenal Ulcer.

Muhammad Faisal Murad,Maham Tariq,Ronald C Merrell,Asif Zafar,Ayesha Akram,Rafeya Khan

doi:10.7759/cureus.10953

Abstract

BackgroundLaparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair.MethodsIn this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation.ResultsThe mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications.ConclusionsLaparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.

Highlights

Since the past decade, there has been an extensive change in the approach to abdominal surgeries from laparotomy to minimal access surgery
The mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively)
perforated duodenal ulcer (PDU) is one complication of the disease that is still not an uncommon presentation in the emergency department (ED). The incidence of this disease is about 1 in 600 emergency presentations during usual months, but various studies published in Pakistan have observed that the incidence of PDU becomes higher during the holy month of Ramadan

Summary

Introduction

There has been an extensive change in the approach to abdominal surgeries from laparotomy to minimal access surgery. Previously published studies warn about pneumoperitoneum-induced bacteremia and delayed recovery [3,4], whereas, on the other hand, there are advantages of early mobilization, less postoperative analgesia requirement, and shorter hospital stay [5,6,7]. One such condition where laparoscopic approach can be considered an option is perforated duodenal ulcer (PDU). PDU is one complication of the disease that is still not an uncommon presentation in the emergency department (ED). The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair

Objectives

Methods

Conclusion