title: Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique.
abstract: OBJECTIVE
  The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution.
  
  
  METHODS
  This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014.
  
  
  RESULTS
  A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n=63, 48.1% vs. open repair, n=68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p=0.434), gender (p=0.305), body mass index (p=0.180), and presence of comorbidities (p=0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p=0.769), Boey scores 0/1 (p=0.311), Mannheim Peritonitis Index > 27 (p=0.528), shock on admission (p<0.99), and the duration of symptoms > 24 hours (p=0.857). There was no significant difference in the operating time between the two groups (p=0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p=0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p=0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p=0.008) and lower pain scores in the immediate postoperative period (p<0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99).
  
  
  CONCLUSIONS
  Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group.
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia; Department of Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Kuching, Malaysia. Electronic address: szeli18@yahoo.com.
authors.forename: Sze Li
authors.initials: SL
authors.lastname: Siow
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia.
authors.forename: Hans Alexander
authors.initials: HA
authors.lastname: Mahendran
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia; Department of Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Kuching, Malaysia.
authors.forename: Chee Ming
authors.initials: CM
authors.lastname: Wong
authors.affiliation: Department of Surgery, Sarawak General Hospital, Kuching, Malaysia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hardin
authors.affiliation: Department of Surgery, Borneo Medical Centre, Kuching, Malaysia.
authors.forename: Tien Loong
authors.initials: TL
authors.lastname: Luk
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
keywords: laparoscopic; open; perforated peptic ulcer; standardized technique; surgical outcomes