Laparoscopy: A Better Approach for Perforated Duodenal Ulcer

Abstract

Background Laparoscopic 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. Methods In 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. Results The 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. Conclusions Laparoscopic 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.

A Comparative Study between Open and Laparoscopic Omental Patch Repair of Perforated Duodenal Ulcer

“…Statistical analysis of the current work elaborated mean value of postoperative immobilization of the patients was 7.3 ± 1.2 hours in the open repair group, and 3.5 ±0.6 in the laparoscopy group. In accordance to our work, several workersreported shorter time needed for mobilization of the patients in laparoscopy, compared to laparotomy [6,28] .…”

“…Simple closure of the perforation with an omental patch is a technically easy, reliable and preferable method [6] . An omental patch is covered to secure the perforation closure and prevent leakage [2].…”

A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer

“…9, Figure 1 shows the PRISMA diagram for the study selection process. Of the 29 studies included, there were 9 studies that did not have open conversion, 9,22,25,[28][29][30]36,42,43 12 studies that were analyzed with intention-to-treat analysis, 23,31,32,34,35,[38][39][40][44][45][46][47] 2 studies analyzed with per-protocol analysis, 26,33 3 studies that separately analyzed LOPR with open conversion, 27,37,41 1 study that did not mention whether studies were analyzed based on intention-to-treat or per-protocol analysis, 24 1 study that excluded open conversions in their analysis, 49 and 1 study that did not report on open conversion. 48 For the three studies that analyzed LOPR with open conversion separately, 27,37,41 we analyzed them using per-protocol analysis.…”

“…There were 19 studies (65.5%) that reported on the expertise of surgeons involved in LOPR 9,[22][23][24][27][28][29][30][31][32]34,[37][38][39][40][42][43][44]46 and 10 studies (34.5%) that reported on the expertise of surgeons involved in OOPR. 23,24,27,28,30,31,34,38,42,44 Of patients who underwent LOPR, there were only three studies that analyzed the proportion of attending surgeons to trainees 23,27,34 and one study that analyzed the impact of seniority of performing surgeon on OT. 37 LOPR was performed mainly by attending surgeons (range, 82.4-91.4%), compared with OOPR, where majority of the performing surgeons were trainees (trainee range, 52.8-96.8%).…”

Duodenal ulcer and its complications

“…The discussion on the comparison of laparoscopic access with laparotomy in the treatment of perforated duodenal ulcers is not yet complete even after a decade. Thanks to recent advances in minimally invasive surgery, laparoscopy is giving more and more promising results, and this should be taken into account for patients with duodenal ulcer perforation, so it is possible that performing laparoscopy instead of laparotomy in this situation may be the best solution (Murad et al, 2020).…”