[A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers].
OBJECTIVE
To compared the clinical efficacy of laparoscopic repair (LR) versus open repair (OR) for perforated peptic ulcers.


METHODS
From January 2010 to June 2014, in Shanghai Tongji Hospital, 119 patients who were diagnosed as perforated peptic ulcers and planned to receive operation were prospectively enrolled. Patients were randomly divided into LR (58 patients) and OR(61 patients) group by computer. Intra-operative and postoperative parameters were compared between two groups. This study was registered as a randomized controlled trial by the China Clinical Trials Registry (registration No.ChiCTR-TRC-11001607).


RESULTS
There was no significant difference in baseline data between two groups (all P>0.05). No significant differences of operation time, morbidity of postoperative complication, mortality, reoperation probability, decompression time, fluid diet recovery time and hospitalization cost were found between two groups (all P>0.05). As compared to OR group, LR group required less postoperative fentanyl [(0.74±0.33) mg vs. (1.04±0.39) mg, t=-4.519, P=0.000] and had shorter hospital stay [median 7(5 to 9) days vs. 8(7 to 10) days, U=-2.090, P=0.001]. In LR group, 3 patients(5.2%) had leakage in perforation site after surgery. One case received laparotomy on the second day after surgery for diffuse peritonitis. The other two received conservative treatment (total parenteral nutrition and enteral nutrition). There was no recurrence of perforation in OR group. One patient of each group died of multiple organ dysfunction syndrome (MODS) 22 days after surgery.


CONCLUSIONS
LR may be preferable for treating perforated peptic ulcers than OR, however preventive measures during LR should be taken to avoid postopertive leak in perforation site.
Qiwei
Q
Wang
Bujun
B
Ge
Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China. hqhq007@hotmail.com.
Qi
Q
Huang
D002681:China; D057186:Comparative Effectiveness Research; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D004750:Enteral Nutrition; D005260:Female; D005283:Fentanyl; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000534:rehabilitation*; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology*; D010289:Parenteral Nutrition, Total; D010439:Peptic Ulcer Perforation / Q000534:rehabilitation* / Q000601:surgery*; D010538:Peritonitis / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome
D005283:Fentanyl