title: Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer.
abstract: BACKGROUND
  Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered.
  
  
  METHODS
  From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded.
  
  
  RESULTS
  Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups.
  
  
  CONCLUSIONS
  In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch.
authors.affiliation: Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, No. 2 Yuh-Der Road, Taichung, 404, Taiwan.
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Lo
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D004381:Duodenal Ulcer / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques; D055815:Young Adult