Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Mortality and Morbidity in Peptic Ulcer Perforation: A

Comparison between Radical Open Repair vs Conservative

Laparoscopic Repair

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Yacine Ben Safta , Neserine Tounsi , Mohamed Maatouk , Aymen Mabrouk , Aymen Ben Dhaou , Mounir Ben Moussa 6
AbstrAct
Introduction: Currently, in the era of robotic surgery and advancement of laparoscopic technology, the place of open surgery has been reduced.
However, the use of laparoscopic surgery for peptic ulcer disease is not yet a consensus.
Materials and methods: All patients who had been operated for perforated peptic ulcer (PPU) disease from January 2005 to December 2014
in our hospital were reviewed retrospectively. Patient demographics, perioperative and intraoperative details, and surgical outcomes were
evaluated. The objective of our study is to compare the clinical and surgical outcomes of patients who underwent either laparoscopic or open
procedure as well as to demonstrate if laparoscopic repair (LR) technique has advantages to open repair (OR) in terms of morbidity and mortality.
Results: We diagnosed 159 patients with PPU during the study period. LR was performed for 65 (41%) patients, and the remaining patients
underwent OR. Morbidity of medical and surgical complication was higher in open groups (21 vs 2) (p value = 0.0001). The most frequent
complication in both groups was medical complication. Overall, 16 patients in the OR group had medical complications vs 2 patients in the LR
group (p value = 0.009). Surgical complication was higher in open groups (7 vs 0) (p value = 0.04). Mortality was statistically higher in the open
group. We did not report any death in the laparoscopic group. However, six deaths were identified in the OR group (p value = 0.04).
Conclusion: Our results indicate that LR for PPU was a safety option with fewer rates of morbidity, reoperation, and mortality compared to OR.
Keywords: Laparoscopic repair, Morbidity, Perforated peptic ulcer.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1411

IntroductIon 1–6 Department of Surgery A21, Charles Nicolle Hospital, University
Peptic ulcer is a current disease. Complications such as acute Tunis El Manar, Tunis, Tunisia
hemorrhage or perforation have been well documented. 1,2 Corresponding Author: Neserine Tounsi, Department of Surgery
Despite the progress of medical treatment [proton pump A21, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia,
inhibitor (PPI) and eradication therapy for Helicobacter pylori], the Phone: +99430944, e-mail: neserine.tounsi@gmail.com
incidence of perforated peptic ulcer (PPU) did not decreas. 3,4 How to cite this article: Safta YB, Tounsi N, Maatouk M, et al. Mortality
Currently, in the era of robotic surgery and advancement of and Morbidity in Peptic Ulcer Perforation: A Comparison between
laparoscopic technology, the place of open surgery has been Radical Open Repair vs Conservative Laparoscopic Repair. World J Lap
reduced. 5 Surg 2020;13(3):97–100.

However, laparoscopic surgery for peptic ulcer disease was not Source of support: Nil
yet recommended by consensus. 6 Conflict of interest: None
It is for this reason that the practice is often confused, which
procedure to choose to cure a patient? abdominal surgery, evidence of concomitant ulcer bleeding,
In the literature, superiority of laparoscopic repair (LR) technique gastric outlet obstruction, or large and suspicious ulcers were
in PPU compared to open repair (OR) surgery was controversial. 7 excluded.
The objective of our study is to compare the clinical and surgical The goal of the study was to compare the results of PPU LR
outcomes of patients who underwent either LR or OR. with OR.
The primary end points were morbidity specific complications
MAterIAls And Methods (intra-abdominal, abscess; anastomosis leakage; secondary

peritonitis; surgical-site infection) and nonspecific complications
We retrospectively reviewed all patients who underwent surgical (urinary tract infection, pulmonary and cardiovascular complications)
repair for PPU in our surgical unit from January 2005 to December and mortality.
2014. The second end point was operation time, the average duration
The puncture site was juxtapyloric for all patients. of nasogastric tube, the average of drainage stays, the average of
The data analyzed included age, sex, American Society of nasogastric tube, longer time of Foley, total analgesic dose, time
Anesthesiologists (ASA) classification, operative details, details to return to normal diet, and overall duration of hospitalization.
of postoperative complications, operative time, the analgesic The decision regarding the method of repair (laparoscopic or
requirement, length of postoperative, hospital stay, and return to open) was dependent on laparoscopic surgical skills of surgeons
normal daily activities. Patients with a history of previous upper and anesthesiologist recommendation.

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