Open vs laparoscopic repair of perforated peptic ulcer.
BACKGROUND
Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer.


METHODS
A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996.


RESULTS
The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly.


CONCLUSIONS
The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.
Bergamaschi
R
R
Division of Gastrointestinal Surgery, Department of Surgery and National Center for Advanced Laparoscopic Surgery, University Hospital of Trondheim, Olav Kyrres Gate 17, Trondheim 7006, Norway.
Mårvik
R
R
Johnsen
G
G
Thoresen
J E
JE
Ystgaard
B
B
Myrvold
H E
HE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome