Perforated Gastroduodenal Ulcers Research Articles

Endoscopic treatment of gastroduodenal perforations

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.

Spectrum of Acute Non Traumatic Diffuse Secondary Peritonitis in the Tropics

Background: Peritonitis is one of the most common surgical emergency in tropical countries. It is still a significant cause of mortality and morbidity. This study aimed to describe the aetiology of acute non traumatic diffuse secondary peritonitis (ANDSP) and to report the outcome after treatment. Material and Methods: A retrospective survey of patients with ANDSP was carried out from January 2007 to December 2016 in the Digestive and General Surgery Service of Bouaké Teaching Hospital in the central part of Côte d’Ivoire. The hospital is a tertiary referral centre and serves urban and rural population from Bouaké’s agglomeration but also from the whole central and northern parts of the country. During the study period, all patients found to have at laparotomy ANDSP were included. The analysed variables include epidemiologic charts, clinical presentation, cause of peritonitis, surgical treatment, postoperative outcome and prognostic factors. Results: Over the studied period 626 cases of ANDSP were operated on. The main aetiologies were gastroduodenal peptic ulcer perforation (n = 252, 41.1%), typhoid ileal perforation (n = 207, 33%) and appendicular peritonitis (n = 123, 19.6%). The mean duration of hospital stay was 13.8 ± 9.6 days (range 8 - 87 days). The length of hospital stay was significantly influenced by postoperative complications (23.5 ± 5.4 days versus 10.8 ± 2.7 days P = 0.000000). Two hundred and sixty one postoperative complications were recorded in 242 patients (38.6%) with wound infection being the commonest postoperative complication. A repeat laparotomy was indicated in 73 patients. Eigthy (n = 80) patients died (mortality 11.2%). Risk factors for death were hemodynamic shock, ASA > II, Age ≥ 60 years, M PI > 29 and digestive sutures performed in septic environment below the transverse mesocolon. Conclusion: The spectrum of aetiology of ANDSP in this tropical area is different from the one observed in the Western countries. Proper treatment of typhoid fever and amoebiasis can reduce the incidence of peritonitis. Early consultation together with adequate resuscitation and surgical management can improve the prognostic which still remains poor.

Laparoscopic treatment versus open treatment of gastroduodenal perforations: our decades of retrospective experience and literature review

Background: The aim of our work is to evaluate the laparoscopic treatment of gastroduodenal ul-cers (GDU) perforated in a territory where the population is multiethnic and where, given that the main activity is agriculture, the presence of non-EU citizens (EX) and of Eastern European citizens (EE) is considerably higher. Methods: From January 2007 to December 2017, 97 patients were operated for perforated GDU in our department all treated within 24 h from admission and/or from the beginning of the sympto-matology, 70 males and 27 females, in most cases they were foreign citizens, the average age was 34 for foreigners and 58 for Italians. In total, 68 were treated by laparoscopy (LS) and 25 by laparoto-my (LT), the cases of conversion from LS to LT were 4 included in a third group. Usual direct su-ture accompanied by omentopexy (OP) if ulcer > of 5 mm and/or if it is in the stomach. Results: The majority of patients treated were foreign: 69 (24 EX and 45 EE, age: 18–55), while 28 were Italians (age: 30–86). In the foreigners the most frequent cause was alcohol and smoking: pre-sent in 60 patients, in the remaining 9 the cause is abuse of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. In the Italians 21 had abused in NSAIDs and/or corticosteroids and 7 had GD pathologies not treated. The average hospitalization was 6 days for the LS and 9 for the LT and average duration was 91 minutes in LT and 65 in LS. Conclusions: The gold standard in the treatment of perforated GDU is LS; LS that we can perform in almost all cases treated both because the majority of patients is foreign and has a lower average age compared with Italians and because we have an operating team trained to deal with this disease. 24 h from the symptomatological manifestation has favored us both in terms of endoabdominal col-lections and in the inflammatory state of the perilesional area. In our experience LS treatment is far superior to LT treatment both in terms of patient benefit and health expenditure and combines the advantages of LS with the reliability of LT treatment.

Perforations of Gastro-Duodenal Ulcers in the Surgery Department “A” at the University Hospital Point G Bamako

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30 - 49 years was the majority. The male sex was dominant with 90.7% of cases; the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

Analysis on the effect of comprehensive nursing intervention on nutritional status and quality of life after perforation of gastroduodenal ulcer

Objective To analyze the effect of comprehensive nursing intervention on the nutritional status and quality of life after perforation of gastroduodenal ulcer. Methods A total of 97 patients with gastroduodenal ulcer treated in this hospital from December 2015 to December 2016 were selected as research subjects.According to the random number table method, they were divided into the intervention group with 49 cases and control group with 48 cases.The patients of the control group was given routine care.On the basis of routine nursing, the intervention group was given comprehensive nursing intervention.The nutritional status and quality of life of the two groups were analyzed and compared. Results After nursing intervention, the contents of transferrin and serum albumin in the intervention group were significantly higher than those in the control group, and the differences were statistically significant(P 0.05). After nursing intervention, the score of quality of life in the intervention group was significantly better than that of the control group, and the difference was statistically significant(P<0.05). After the intervention, the complication rate of the intervention group was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). The 1-year recovery rate of the intervention group was significantly higher than that of the control group(P<0.05). The length of stay in the intervention group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.05). The satisfaction degree of patients in the intervention group was significantly higher than that of the control group, and the difference was statistically significant(P<0.05). Conclusions Comprehensive nursing intervention after perforation of ulcer in gastroduodenal ulcer patients can improve the nutritional status, improve the quality of life and reduce the occurrence of postoperative complications.Comprehensive nursing intervention can promote the early recovery of patients, and the postoperative recovery rate is high, thus improving the patients' satisfaction with the nursing service.It is worthy of clinic application. Key words: Gastroduodenal ulcer; Perforation of ulcer; Comprehensive nursing intervention; Nutritional status; Quality of life

The complex treatment of patients with perforated gastroduodenal ulcers

To improve the immediate results of surgical treatment of patients with perforated gastroduodenal ulcers using minimally invasive correction and an integrated treatment. The results of 253 patients with perforated gastroduodenal ulcers who were treated from 2013 to 2018 were analyzed. Chronic ulcers were found in 82 (32%) cases among all gastric ulcers, acute ones constituted 42 (16%) cases. Chronic duodenal ulcers reached 94 (37%), acute ones constituted 35 (14%). The diagnostic laparoscopy was performed in 13 (5%) patients, in 8 (3%) patients the perforated hole was sutured laparoscopically and in 5 (2%) patients the conversion was performed. Abdominocentesis with preoperative abdominal cavity drainage was carried out in 45(18%) patients. Through this drainage after exudate evacuation 200 ml of dekasan solution was injected. In 119 cultures of abdominal exudates with determinate pathogenic microflora Enterococcus faecalis dominated - 31 patients (26%). Among the postoperative complications the failure of intestinal sutures was observed in 4 (1.5%) patients. Postoperative mortality was 11.5%. Progression of multiple organ failure became the cause of mortality in 17 (59%) patients. Thus, the time from the moment of perforation till the moment of surgery must not be the sole criterion in the choice of method of operative intervention, and it is insufficient as an absolute indicator for the possibility of the radical surgical procedures (gastric resection). Undoubtedly laparoscopic suturing of the perforated gastroduodenal ulcer has advantages over laparotomy.

End Stage Renal Disease is Associated with Increased Mortality in Perforated Gastroduodenal Ulcers

Patients with end stage renal disease (ESRD) represent a growing subset of surgical candidates and ESRD status has been associated with increased morbidity and mortality in other operations. Using a national database, we examined outcomes and risk factors for patients presenting with perforated gastroduodenal ulcers undergoing omentopexy. We identified adult and emergent patients with perforated duodenal and gastroduodenal ulcers that underwent omentopexy using the 2005 to 2012 Nationwide Inpatient Sample. We identified patients with ESRD status and assessed comorbidity status using the Elixhauser-van Walraven score. Univariate and multivariable logistic regression analyses were performed. Inpatient mortality was the primary outcome. Six thousand five hundred and twenty-one patients were identified. Median age was 59.0 years, majority were male (55.56%), 79 (1.21%) patients had ESRD, 367 (5.63%) patients died during admission. Multivariable logistic regression showed age (OR 2.71, P < 0.0001), Elixhauser-van Walraven score (OR 2.69, P < 0.0001), and ESRD status (OR 3.88, P < 0.0001) as independent risk factors for mortality. ESRD was associated with increased mortality in patients undergoing omentopexy for perforated gastroduodenal ulcers. Future studies are necessary to identify methods to increase perioperative survival.

Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduodenal ulcers

Surgery is the treatment of choice for perforated peptic ulcer disease. The aim of the present review was to compare the perioperative outcomes of acute laparoscopic versus open repair for peptic ulcer disease. A systematic literature search was performed for randomized controlled trials (RCTs) published in PubMed, SCOPUS, and Web of Science. The search included eight RCTs: 615 patients comparing laparoscopic (307 patients) versus open peptic perforated ulcer repair (308 patients). Only few studies reported the Boey score, the Acute Physiologic Assessment and Chronic Health Evaluation score, and the Mannheim Peritonitis Index. In the RCTs, there is a significant heterogeneity about the gastric or duodenal location of peptic ulcer and perforation size. All trials were with high risk of bias. This meta-analysis reported a significant advantage of laparoscopic repair only for postoperative pain in first 24 hours (-2.08; 95% confidence interval, -2.79 to -1.37) and for postoperative wound infection (risk ratio, 0.39; 95% confidence interval, 0.23-0.66). An equivalence of the other clinical outcomes (postoperative mortality rate, overall reoperation rate, overall leaks of the suture repair, intra-abdominal abscess rate, operative time of postoperative hospital stay, nasogastric aspiration time, and time to return to oral diet) was reported. In this meta-analysis, there were no significant differences in most of the clinical outcomes between the two groups; there was less early postoperative pain and fewer wound infections after laparoscopic repair. The reported equivalence of clinical outcomes is an important finding. These results parallel the results of several other comparisons of open versus laparoscopic general surgery operations-equally efficacious with lower rates of wound infection and improvement in some measures of enhanced speed or comfort in recovery. Notably, the trials included have been published throughout a considerable time span during which several changes have occurred in most health care systems, not least a widespread use of laparoscopy and increase in the laparoscopic skills. Systematic review and meta-analysis, level III.

Delayed surgery in a patient with pneumococcal peritonitis and bacteremia secondary to perforation of gastroduodenal ulcer

Rationale:Very few cases of secondary peritonitis caused by Streptococcus pneumoniae have been described in the literature, and they have been found to occur mostly in patients with predisposing factors. Here, we report the case of an elderly patient who developed pneumococcal peritonitis secondary to perforation of gastroduodenal ulcer.Patient concerns:An 82-year-old man was admitted to intensive care unit (ICU) for septic shock with cardiac impairment 1 day after arriving in the Emergency Department.Diagnoses:The patient presented with pneumococcal bacteremia and pneumococcal antigenuria. No abdominal defense was found on examination. A computed tomography scan revealed pneumoperitoneum and peritoneal effusions.Interventions:The patient was treated with effective empiric antibiotic therapy, and delayed surgery.Outcomes:The patient gradually improved and was discharged from ICU on day 14. The ultimate outcome was unfavorable, with death occurring on day 28.Lessons:This rare infection can occur in elderly patients even in the absence of other predisposing factors. Secondary peritonitis may be suspected in patients with positive pneumococcal antigenuria or unexplained pneumococcal bacteremia, especially if an asthenic form is possible.

Laparoscopy for perforated gastroduodenal ulcers

To assess laparoscopy in diagnosis and treatment of patients with perforated gastroduodenal ulcers. There were 273 patients with perforated gastroduodenal ulcers who underwent laparoscopy at the Sklifosovsky Research Institute for Emergency Care in 2010-2016. Sample included patients with clinical and instrumental diagnosis of perforated gastroduodenal ulcers, suspected hollow organ perforation including perforated ulcer and other acute abdominal diseases followed by perforated ulcer. Laparoscopy confirmed diagnosis of perforated gastroduodenal ulcer in 82.5% of patients with clear preoperative diagnosis and in 54.2% of patients with suspected perforated ulcer. Video-assisted closure of the ulcer is possible in 81.7% of patients. Any endoscopic procedure should be started from diagnostic measures. Diagnostic laparoscopy followed by curative laparotomy in 14.6% of patients was able to clarify diagnosis, suture technically difficult perforated ulcer and prevent possible complications.

Systematic review of curative effect between laparoscopic and open repair for perforated gastroduodenal ulcer

Background and Objectives: The effectiveness and safety of laparoscopic operation for perforated gastroduodenal ulcer remains controversial. To provide the evidence of rational operations for both doctors and patients by systematically reviewing the curative effect of laparoscopic and open repair for perforated gastroduodenal ulcer. Methods: The Randomized Controlled Trials (RCTs) about the curative effect of laparoscopic surgery and open repair for perforated gastroduodenal ulcer were electronically searched from the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), International Statistical Institute (ISI). The standard of literature enrolment and exclusion was made, according to which the literatures were selected. Jadad scale was used to evaluate the chosen study. Data were extracted from these trials and data meta-analysis was performed by RevMan 5.2 software. Results: Thirteen RCTs involving one thousand and eighteen patients were included (505 patients in the laparoscopic repair group and 513 patients in the open repair group). Meta-analysis showed that compared with conventional open repair group, laparoscopic repair group could reduce the intraoperative blood (P<0.00001)the postoperative time of recovery of intestinal peristalsis (P<0.00001), the off-bed time (P<0.00001), the use of analgesia after operation (P=0.0002), the chance of wound infection after operation (P<0.00001), the ileus after operation (P=0.02), the postoperation hospital stay (P<0.00001). But there was no statistically significant difference in the other curative effect between the two groups, including the operation time (P=0.49), pneumonia after operation (P=0.68), the abdominal abscess after operation (P=0.07), death after operation (P=0.20), the total expense of hospital (P=0.21). Conclusion: The overall curative effect of laparoscopic repair group in the treatment of perforated gastroduodenal ulcer is better than that of conventional open repair group. Laparoscopic repair for perforated gastroduodenal ulcer is an acceptable alternative.

Minimally invasive surgeries for perforated gastroduodenal ulcers

Minimally invasive surgeries for perforated gastroduodenal ulcers

Risk factors for reintervention after surgery for perforated gastroduodenal ulcer.

Perforated gastroduodenal ulcer carries a high mortality rate. Need for reintervention after surgical repair is associated with worse outcome, but knowledge on risk factors for reintervention is limited. The aim was to identify prognostic risk factors for reintervention after perforated gastroduodenal ulcer in a nationwide cohort. All patients treated surgically for perforated gastroduodenal ulcer in Denmark between 2003 and 2014 were included using data from the Danish Clinical Register of Emergency Surgery. Potential risk factors for reintervention were assessed, and their crude and adjusted associations calculated by the competing risks subdistribution hazards approach. A total of 4086 patients underwent surgery for perforated gastroduodenal ulcer during the study interval. Median age was 71·1 (i.q.r. 59·6-81·0) years and the overall 90-day mortality rate was 30·8 per cent (1258 of 4086). Independent risk factors for reintervention were: male sex (adjusted hazard ratio (HR) 1·46, 95 per cent c.i. 1·20 to 1·78), in-hospital perforation (adjusted HR 1·36, 1·11 to 1·68), high BMI (adjusted HR 1·49, 1·10 to 2·01), high ASA physical status grade (adjusted HR 1·54, 1·23 to 1·94), shock on admission (adjusted HR 1·40, 1·13 to 1·74), surgical delay (adjusted HR 1·07, 1·02 to 1·14) and other co-morbidity (adjusted HR 1·24, 1·02 to 1·51). Preadmission use of steroids (adjusted HR 0·59, 0·41 to 0·84) and age above 70 years (adjusted HR 0·72, 0·59 to 0·89) were associated with a reduced risk of reoperation. Obese men with coexisting diseases and high disease severity who have surgery for gastroduodenal perforation are at increased risk of reoperation.

Preperitoneal Blockade in the Treatment of Patients with Perforated Gastroduodenal Ulcers and Peritonitis

The objective of this study was to improve the results of surgical treatment for patients with perforated gastroduodenal ulcers and peritonitis (PGDU-P) by applying the preperitoneal blockade. Materials and Methods: The study included 102 patients with perforated gastroduodenal ulcers (PGDU) complicated by peritonitis. Patients between 18 and 30 years were predominant. Pain was measured using the Visual Analog Scale (VAS) for Pain. The measurements of intra-abdominal pressure (IAP) by indirect infravesical tensometry were performed daily from the first day after the operation. Surgical interventions (laparotomy, laparoscopic suturing of PGDU, sanitation and drainage of the abdominal cavity) was performed under endotracheal anesthesia in all patients. Patients were divided into two groups depending on the method of postoperative analgesia. Patients of Group 1 (n=62) were subjected only to systemic opioid analgesia (an intramuscular injection of 1% solution of Promedol 1ml 4 times a day). Patients of Group 2 were subjected to systemic opioid analgesia and catheterization of the preperitoneal space for infusion of 0.5% solution of Novocaine in the postoperative period. Results: Postoperative analgesia using preperitoneal blockade after laparotomy and suturing of perforated gastroduodenal ulcers reduced the pain intensity by 2 times in comparison with conventional analgesia. The preperitoneal blockade after laparotomy in PGDU-P patients promotes the effective reduction of intra-abdominal hypertension (IAH) for 2 days. The comparative evaluation of the incidence of the early postoperative complications showed that using preperitoneal blockade contributed to significantly reducing the complications in Group 2. Postoperative mortality was 1.6% in Group 1 and 0 in Group 2. The average length of stay was reduced by approximately 3 days in Group 2 compared to traditional anesthesia. (Int J Biomed. 2016;6(2):114-118.).

Clinical patterns of presentation and attenuated inflammatory response in octo- and nonagenarians with perforated gastroduodenal ulcers

Perforated gastrodudenal ulcer (PGDU) is an operative emergency with high mortality rates. The growing elderly population increasingly presents with need for geriatric acute operative care. Current knowledge of age-specific characteristics in presentation, diagnosis, and outcome for PGDU in the elderly is scarce. We reviewed a consecutive, population-based cohort of patients with PGDU, octa- and nonagenarians were compared with younger patients for variation in patterns of presentation and outcomes. Patterns and outcomes observed included 30-day mortality, serious complications (Clavien-Dindo 3 and 4), and duration of stay. Of the 244 patients, 127 were women (52%); median age was 68years; and 59 patients (24.2%) were ≥80years. Two thirds had gastric ulcers (n=168; 67.2%). On admission, hemoglobin levels, white blood cell count, and serum levels of C-reactive protein, bilirubin, and albumin differed significantly between the age groups. Diagnosis, treatment, and the occurrence of severe complications did not differ with age. The median hours of delay to definitive treatment did not differ significantly for all ages, but patients ≥80years had a greater proportion (44.1% compared with 25.8%) of delay >12hours (odds ratio 2.26, 95% confidence interval 1.22-4.17; P=.008). Overall mortality was 38 (15.6%); no deaths occurred in patients <55years. Over one half of deaths occurred in those ≥80years (odds ratio 4.76, 2.30-9.83; P<.001). Duration of hospital stay was significantly greater in elderly survivors, and fewer were discharged within a week. Octa- and nonagenarians with PGDU present with fewer signs of peritonitis and have an attenuated inflammatory response. The very elderly have twice the risk of long delays to definitive treatment and almost 5 times increased risk of mortality.

Surgical treatment of perforated gastroduodenal peptic ulcers: comparison between open and laparoscopic approach

Background: Laparotomy has long been the standard treatment of perforated peptic ulcers. Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. The aim of this study is to compare the surgical outcomes of patients with perforated gastric or duodenal peptic ulcers treated either open or laparoscopic in our institution. Methods: We retrospectively reviewed records of patients with perforated peptic ulcers who underwent laparoscopic repair or open repair, from January 2013 to May 2016 in our hospital. We analyzed preoperative patient baseline parameters, and intraoperative and postoperative outcomes. Results: Repair of perforated peptic ulcers was performed in 27 patients, using laparoscopic surgery for 14 patients and open surgery for 13 patients. The comparison between the two groups revealed statistically similar results regarding age, gender, BMI and ASA score. Laparoscopic repair was associated with less estimated blood loss (20 vs. 121.5 mL, p=0.025), less duration of nasogastric decompression (1.2 vs. 3.4 days, p=0.000), faster return to diet (2.5 vs. 4 days, p=0.0001) and shorter hospital length of stay (5.5 vs. 7 days, p=0.019). There were no significant differences between the two procedures with regard to operative time (103.9 vs. 101.2 min), use of abdominal drains (71.4% vs. 76.9%) and in-hospital complications (7.1% vs. 15.4%). Conclusions: Laparoscopic repair of gastroduodenal perforations provides a safe and feasible alternative treatment to perforated gastroduodenal peptic ulcers. Results in our study are in concordance with results published globally.

Investigation of the Indications for Conservative Therapy to Treat Perforated Gastroduodenal Ulcers

Investigation of the Indications for Conservative Therapy to Treat Perforated Gastroduodenal Ulcers

Brief Useful Comments on Laparoscopic Surgery in Acute Abdomen

The use of laparoscopic surgery tends to become more and more popular, nowadays. It has also been extended in the management of acute abdominal disease as a diagnostic and as a therapeutic tool. However, its therapeutic use requires special experience and appropriate instrumentation, in addition to a reliable definite diagnosis. Based on randomized, controlled trials, it can be postulated that laparoscopic surgery in acute abdomen is feasible, safe and effective in acute cholecystitis, acute appendicitis and gastroduodenal ulcer perforation. There are still conflicting aspects in perforated diverticular disease and small bowel obstruction. In case of purulent peritonitis attention must be paid in order to avoid residual abscess formation and sepsis by thorough irrigation of the peritoneal cavity and on time antibiotic therapy. The proper indication for each case under the certain emergency circumstances is crucial.

Clinical effects of laparoscopicvsopen surgery for repair of gastroduodenal ulcer perforation

Clinical effects of laparoscopic<i>vs</i>open surgery for repair of gastroduodenal ulcer perforation

Laparoscopic closure of perforated gastro-duodenal ulcer: 15 years' experience in our centre.

IntroductionThe objective of the study is to share the results and development findings on the laparoscopic closure technique applied in our centre during a 15-year period (1998–2012).AimTo compare statistically the standard parameters (hospitalization, duration of operation) versus conventional surgery, and at the same time we compared mainly morbidity and mortality.Material and methodsDuring the period under review we operated on a total of 259 patients, 115 (44.4%) of them laparoscopically, and 144 (55.6%) of them conventionally. The sample was divided into two groups: patients with ASA physical status classification system 1–3, and patients with ASA 4–5.ResultsThe results favour laparoscopy within the group with ASA 1–3 in terms of several parameters, namely: duration of hospitalization – 7.7 days in the case of laparoscopic intervention, vs. 10.6 days for conventional surgery (p < 0.05); and duration of operation – 61 min vs. 85.1 min respectively (p < 0.05). Total morbidity was 27.5% in the case of patients with conventional surgery, vs. 10.9% with laparoscopic intervention (p < 0.05). The sample of patients with ASA 4–5 suffered a high mortality of 82.7%.ConclusionsLaparoscopic closure of perforated ulcer is a safe therapeutic method, as confirmed by the results of many other studies around the world, which in many aspects favour the laparoscopic technique.