Laparoscopic Repair of Perforated Peptic Ulcer: A Report of 58 Cases
Keywords:
Perforated peptic ulcer, Laparoscopic repair, Simple closure, Site leakAbstract
Objective: The most common cause of gastroduodenal perforation is a perforated peptic ulcer (PPU). Laparoscopic repair has proved to be beneficial over open repair in terms of less post-op pain and a shorter length of stay. However, complications from site leak and intra-abdominal abscess are more common. The author reported the outcomes of three laparoscopic repair procedures: simple closure alone (SC), simple closure with omental patch (SCO), and simple closure alone with leak test (SCL) in 58 patients who presented with perforated gastroduodenal lesions.
Methods: Between July 2011 and October 2020, retrospective data of 58 patients with gastroduodenal perforation and underwent SC, SCO, and SCL were analyzed.
Results: There were 57 benign peptic ulcers and 1 gastric cancer perforation. Laparoscopic surgery was accomplished in 52 cases (89.7%) and was converted to open surgery in 6 cases (10.3%). SCO was performed in 13 cases (22.4%), SC in 15 cases (25.9%) and SCL in 24 cases (41.4%). In the SCL group, wound leakage was detected in 2 cases (8.3%) and both were corrected intra-operatively. There was no site leak or intra-abdominal abscess in this study, and no re-operation was required. Two deaths (3.4%) were found in this study.
Conclusion: SCO for large ulcers was a safe procedure but took longer operative time. SC for small ulcer was secure with shorter operative time. SCL for high-risk ulcers could detect site leak intra-operatively and could prevent post-operative complications.
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