Laparoscopic versus Open Repair of Perforated Peptic Ulcer: Comparative Study

Abstract
Background: Despite the well known benefits of minimal invasive surgery, up till now, there is a marked controversy regarding the real benefits of laparoscopic repair of Perforated Peptic Ulcer (PPU).
Aim of the Study: The early outcome results of laparoscopic and open repair of PPU were compared to assess the feasibility and safety of laparoscope.
Patients and Methods: Patients with clinical diagnosis of PPU, admitted at Mansoura University Hospital over the period between December 2013 and December 2017, were included in the study after a written consent. They were prospectively randomized for laparoscopic or open repair using pedicled omental patch technique. The pre-operative, operative, and post-operative data were collected for statistical analysis.
Results: This study comprised 80 patients, out of them ten excluded due to detection of other pathologies, 33 remained in the laparoscopic group and 37 patients in the open group. The conversion rate from laparoscopic into open technique was (45.5%). The laparoscopic technique in comparison with the open technique showed a significantly longer operative time (61min vs. 46.54min; respectively), shorter hospital stay (5.72 vs. 8.77 days; respectively), lower post-operative anal-gesia requirements (111.11 vs. 268.27mg pethidine/day; respectively), and a lower rate of wound infection (5.6% vs. 34.6%; respectively). The laparoscopic and open groups had a comparable incidence of pulmonary complications, wound dehiscence, leakage, ileus, and intra-abdominal collection. There were no mortalities in the laparoscopic group while there were 6 mortalities in the open group (11.5%). Conversion did not affect the outcome of open repair except for prolon-gation of operative time.
Conclusion: Laparoscopic repair of PPU is equally feasible and safe in comparison to the open repair in patients with low surgical risk.