title: Management of perforated peptic ulcer in a district general hospital.
abstract: BACKGROUND
  Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose  of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons.
  
  
  METHODS
  Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures  including operative time, length of hospital stay and mortality.
  
  
  RESULTS
  The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically  (5 days) when compared with the open group (6 days) ( p <0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs.
  
  
  CONCLUSIONS
  Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.
authors: Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK. adamcritchley@doctors.net.uk
authors: A C
authors: AC
authors: Critchley
authors: A W
authors: AW
authors: Phillips
authors: S M
authors: SM
authors: Bawa
authors: P V
authors: PV
authors: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D004739:England; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult