[Perforated duodenal ulcer: benefits and risks of laparoscopic repair].
OBJECTIVE
Laparoscopic perforated duodenal ulcer repair is a minimally invasive technique. Just like any other type of surgery, the laparoscopic approach carries operative risks in itself. The primary goal of this article is to describe the possible risk factors in laparoscopic duodenal ulcer repair. The secondary goal is to clarify benefits of the laparoscopic surgery.


METHODS
The Medline/Pubmed database was used; 73 articles were analyzed and evaluated.


RESULTS
Six retrospective and nine prospective studies are summarized. The retrospective studies' results are as follows: total complication rate is 7-28% (average--16%); conversion rate is 6-30% (average--18%); postoperative mortality rate is 0-20% (average--6%); and average hospital stay is 6-17 days (average--8 days). The results of the prospective studies are the following: total complication rate is lower--5-25% (average--11%); conversion rate is lower - 0-27% (average--14%); postoperative mortality is lower 0-10% (average--3%); and average hospital stay is shorter--4-10 days (average--6 days). The difference is not significant but the results are better than in prospective studies. The risk factors were identical.


CONCLUSIONS
Shock, delayed presentation (>24 hours), confounding medical condition, age >70 years, American Society of Anesthesiology III-IV degrees and Boey score--all above should be considered as preoperative laparoscopic repair risk factors. Inadequate ulcer localization, large perforation size (>6 mm diameter according to ones, >10 mm according to others) and ulcers with friable edges are also considered as laparoscopic repair risk factors: each of the factors independently is an indication for an open repair.
Lunevicius
Raimundas
R
Clinic of General and Vascular Surgery, Vilnius University, Center of General Surgery, 2nd Department of Abdominal Surgery, Vilnius University Emergency Hospital, Lithuania. rlunevichus@yahoo.com
Morkevicius
Matas
M
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D004381:Duodenal Ulcer / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015167:Vagotomy, Truncal
D015718:Fibrin Tissue Adhesive