Page 13 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

10.5005/jp-journals-10033-1173
A Comparative Study of Laparoscopic vs Open Surgery for the Management of Duodenal Ulcer Perforation
ORIGINAL ARTICLE
A Comparative Study of Laparoscopic vs Open Surgery

for the Management of Duodenal Ulcer Perforation

PN Sreeramulu, TS Venkatachalapathy, CS Supreet, S Prathima

ABSTRACT of benefit. Unlike many of the procedures that have
established the role of laparoscopy in elective upper
Approximately, 10 to 20% of patients with peptic ulcer suffer a
perforation of stomach or duodenum in which chemical peritonitis GI surgery, however, it is performed in patients with
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develop initially from gastric and duodenal secretion but in a generalized peritonitis and the often severe physiological
few hours bacterial contamination superimpose the disease. disturbances which may accompany this. The
The disease could be life-threatening, early diagnosis and
treatment is extremely important. The mortality will increase up pathophysiological insult of a ‘tension CO pneumo-
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if perforation exists more than 24 to 48 hours. Usually the only peritoneum’ during laparoscopy may be exaggerated in such
surgical procedure that is necessary is simple closure with patients, while the effect on the immune system and its
omental patch. When repair of perforated ulcer can be achieved
by suture closure, laparoscopic approach seems to be mediators is unpredictable. The balance of exchanging the
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appropriate. This study aims at evaluating efficacy, safety and obvious postoperative benefits of rapid recovery, reduced
outcome of laparoscopic surgery for perforated duodenal ulcer. wound complications, improved respiratory function and
Patients admitted with perforated duodenal ulcer perforation,
during the period of January 2010 to January 2011 at RL Jalappa improved cosmetic appearance for an increase in
Hospital and Research Center were evaluated. A total 61 cases intraoperative physiological compromise may be in favor
were diagnosed as peritonitis secondary to duodenal perforation of laparoscopic surgery in relatively fit elective patients,
were involved in study. Thirty underwent laparoscopic closure but may be considerably more marginal in ill patients at
and 31 underwent open surgeries which were nonrandomized.
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The results of study revealed lesser antibiotic open: lap (5:4.03 risk of multiple organ dysfunction syndrome (MODS). To
days; p = 0.001), analgesic requirement (7:4.87 days; p = 0.001) examine the risks and benefits of laparoscopic surgery for
and lesser hospital stay (8:6.17 days; p = 0.001) and reduced perforated peptic ulcers, this nonrandomized cohort
postoperative complications open-three (9%): lap-one (3%)
patients. The duration of surgery was more with laparoscopic comparison compared a consecutive series of laparoscopic
surgery (open-56: lap-62.17 minutes; p = 0.003) since we are repairs of perforated peptic ulcers (lap group) 10-12 with a
at initial stages at laparoscopic management for DU perforation, concurrent series of consecutive open repairs (open group).
also depend on skill of surgeon but it had no effect on the overall
outcome. Three (9.6%) patients in lap group were needed MATERIALS AND METHODS
conversion to open surgery.
All patients diagnosed clinically with perforated peptic
Keywords: Laparoscopy, Peritonitis, Duodenal ulcer perforation.
ulcers were prospectively nonrandomized to undergo either
How to cite this article: Sreeramulu PN, Venkatachalapathy TS, conventional open or laparoscopic suture omental patch
Supreet CS, Prathima S. A Comparative Study of Laparoscopic 13-16
vs Open Surgery for the Management of Duodenal Ulcer repair (consent and cafeteria approach) who are admitted
Perforation. World J Lap Surg 2013;6(1):11-14. to RL Jalappa Hospital and Research Center attached to Sri
Devaraj Urs Medical College, Tamaka, Kolar. The study
Source of support: Nil
protocol was approved by the hospital ethics committee
Conflict of interest: None declared before the trial began from January 2010 to January 2011.
Informed consent for randomization to laparoscopic or open
INTRODUCTION
omental patch repair was obtained from all patients.
Laparoscopic repair of perforated peptic ulcers is now A total of 61 patients were included in the study with 30 in
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technically feasible and, in the small series reported to lap group and 31 in open group. 17-20 Patients with a surgical
date, carries many of the minimal access advantages diagnosis other than perforated peptic ulcer and previous
apparent in other upper gastrointestinal (GI) and biliary abdominal surgery were excluded at surgery. Following
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procedures. With the establishment of the role of parameters were noticed: operative duration, analgesics and
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Helicobacter pylori eradication making simple over antibiotics requirement (pre- and postoperative),
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sewing of perforated ulcers an effective long-term solution, postoperative hospital stay, local and systemic
the laparoscopic procedure is increasingly within the complications. All the cases underwent preoperative
compass of surgical trainees and, as the role of routine assessment, the decision to operate laparoscopic or open
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laparoscopy in the diagnosis and management of peritonitis surgery depending on the patient presentation. Their
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becomes accepted, it is in danger of being seen as the preoperative and intraoperative, postoperative findings and
procedure of choice without prior evaluation or evidence complications were meticulously recorded as per protocol. 23
World Journal of Laparoscopic Surgery, January-April 2013;6(1):11-14 11