Open versus Laparoscopic Management of Gastroduodenal Ulcer Perforation: A Single-Institution Comparative Experience

Background: Laparoscopic repair of perforated ulcers has been recently proposed as an alternative to the conventional ( open) technique. However, the advantages of the laparoscopic method are less apparent in most published series. This study compared the outcomes of laparoscopic and open approaches for the repair of gastroduodenal perforations, and assessed the feasibility and efficiency of the laparoscopic approach. Patients and Methods: From July 2002 to July 2006, 176 patients with a preoperative diagnosis of perforated peptic ulcer were identified. The following parameters have been retrospectively analyzed to measure and compare the outcomes: operative time, length of hospital stay, blood loss, and postoperative complications. All patients were analyzed on an intention-to-treat basis. Results: Two cases with gastric cancer were excluded form this study. Of the remaining 174 patients, 90 underwent open repair of a perforated ulcer, and 84 were commenced laparoscopically including 6 conversions to open procedure. The 2 groups were matched for age, gender, and other patient characteristics. The laparoscopic group had less blood loss, earlier bowel function, lower dosage of analgesic drugs, shorter hospitalization time, and lower total morbidity, but there was no significant difference in the mean operating time between 2 groups. Conclusions: Laparoscopic repair of perforated ulcers is technically feasible. It is a minimally invasive technique with the benefits of less blood loss, shorter hospitalization, quicker return of bowel function, and a lower dosage of analgesic drugs.