title: Laparoscopic versus open operation for perforated peptic ulcer in pediatric patients: A 10-year experience.
abstract: BACKGROUND
  Perforated peptic ulcer (PPU) is a relatively uncommon condition in children. We aim to evaluate and compare the outcomes of laparoscopic omental patch repair versus open repair for PPU in pediatric patients.
  
  
  METHODS
  Children who underwent omental patch repair for PPU from 2004 to 2014 in our hospital were reviewed retrospectively. Patient demographics, perioperative as well as intraoperative details and surgical outcomes, were analyzed.
  
  
  RESULTS
  Thirteen patients were identified, and all presented with abdominal pain. The median age of the study group was 14.9years (range 6.3 to 18.4years). Radiological evidence of pneumoperitoneum on erect chest x-ray (CXR) was found only in five patients (38.5%). None of the patients had a known history of peptic ulcer disease. Diagnosis other than PPU was made in five patients preoperatively. Laparoscopic repair was attempted in eight patients with one of them requiring conversion. There was no significant difference in patient demographics when compared with the open repair group. The perforation site was in the duodenum in 11 patients and in the antrum in two patients. The mean size of perforation was larger in the open repair group (p=0.005). Although the operating time was longer in the laparoscopic group (p=0.51), the length of hospital stay was significantly shorter (p=0.048). Only two patient diseases were Helicobacter pylori related.
  
  
  CONCLUSIONS
  Clinical features of perforated peptic ulcer in children are different from adults. Risk factors are less frequently identified. Laparoscopic omental patch repair is a feasible surgical option and is associated with satisfactory outcomes in pediatric practice.
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
authors.forename: Carol W Y
authors.initials: CW
authors.lastname: Wong
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
authors.forename: Patrick H Y
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
authors.forename: Paul K H
authors.initials: PK
authors.lastname: Tam
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. Electronic address: kkywong@hku.hk.
authors.forename: Kenneth K Y
authors.initials: KK
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009852:Omentum / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Children; Patch repair; Pediatric; Perforated peptic ulcer