[Laparoscopic repair of perforated duodenal ulcer: early postoperative results and risk factors].

BACKGROUND: Clear patient selection criteria and indications for laparoscopic repair of perforated duodenal ulcers are still of relevance. The purpose of our paper is to describe the early outcome results after this operation and to define the risk factors influencing the genesis of postoperative morbidity.

PATIENTS AND METHODS: Fifty-one patients were operated on laparoscopically between October 1996 and October 2003 for perforated peptic ulcers. Out of them, 47 patients with perforated duodenal ulcers entered the final retrospective analysis. Twenty variables were identified, including the duration of acute symptoms before the operation, shock, underlying medical illness, ulcer size, age, Boey score and the predictive value of these variables for morbidity, conversion rates and hospital stay. The univariate data analysis was originally done using the Fisher exact test, t test, Mann Whitney, ANOVA and F tests. The data was reevaluated using multifactorial analysis with logistic and linear regression tests.

RESULTS: Patient's age was 32.0+/-12.4 years. Duration of perforation was 8.0+/-10.8 hours. Shock was diagnosed in one patient (2.1%). High surgical risk according to ASA (III-IV) was estimated in 2 patients (4.3%). Laparoscopic duodenography was completed in 36 patients (76.6%). The other 11 patients (23.4%) underwent a conversion to open repair. Seven patients (19.4%) had postoperative complications. Suture leakage was confirmed in 4 patients (11.1%), and other abdominal complications were observed in 3 patients (8.3%). Pneumonia and pneumothorax were diagnosed in 3 patients. Hospital stay was 7.9+/-5.8 (4-45) days. There was no mortality. Ulcer perforation size >4-10 mm is the only significant risk factor influencing the conversion rate. An increase in the suture leakage rate was most significant with delayed presentation of >or=10 hours (p<0.0001). This risk factor influences both the postoperative pneumonia rate (>or=10 hrs., p=0.026) and hospital stay (p<0.05).

CONCLUSION: Size of duodenal ulcer perforation and duration of ulcer perforation symptoms were found to be risk factors influencing the rates of conversion to open repair and genesis of postoperative morbidity.