Comparison of laparoscopic versus open repair for perforated duodenal ulcers.

BACKGROUND: There is great controversy regarding the choice of procedure for perforated duodenal ulcer patients. The purpose of this study was to compare the early outcome results of laparoscopic and open repair and to propose which risk factors influence the outcome.

METHODS: Between October 1996 and May 2004, 60 patients underwent laparoscopic and 162 patients underwent open repair of perforated peptic ulcers in a tertiary care academic center. The results were retrospectively analyzed. The primary outcome measures included operative time, duration of hospital stay, morbidity, and mortality.

RESULTS: The operative time was significantly longer in the laparoscopy group compared to the open repair group (76.2 +/- 35.3 vs 57.3 +/- 26.1 min, respectively). The hospital stay in surviving patients appeared to be significantly shorter after laparoscopy than after open repair (7.8 +/- 5.3 vs 10.3 +/- 10.6 days, respectively). Eight patients (13%) in the laparoscopic group and 41 patients (25%) in the open repair group had morbidity in the postoperative period. Suture leakage was confirmed in four patients (7%) following laparoscopic repair and in three patients (2%) in the open repair group. There were 20 deaths (9%), all in the open repair group.

CONCLUSIONS: Independent Boey risk factors, patient age, and large perforation size have a negative impact on patient recovery. Both laparoscopic and open repair are equally safe and effective in perforated duodenal ulcer patients with a Boey score of 0 or 1.