RANDOMIZED STUDY COMPARING LAPAROSCOPIC VERSUS OPEN REPAIR OF PERFORATED PEPTIC-ULCER USING SUTURE OR SUTURELESS TECHNIQUE

Objective This study compares laparoscopic versus open repair and sutu re versus sutureless repair of perforated duodenal and juxtapyloric ul cers. Background Data The place of laparoscopic repair of perforated p eptic ulcer followed by peritoneal toilet of the peritoneal cavity has been established. Whether repair of the perforated peptic ulcer by th e laparoscopic approach is better than conventional open repair and wh ether sutured repair is better than sutureless repair are both undeter mined. Methods One hundred three patients were randomly allocated to l aparoscopic suture repair, laparoscopic sutureless repair, open suture repair, and open sutureless repair. Results Laparoscopic repair of pe rforated peptic ulcer (groups 1 and 2) took significantly longer than open repair (groups 3 and 4; 94.3+/-40.3 vs. 53.7+/-42.6 minutes; Stud ent's t test, p <0.001), but the amount of analgesic required after la paroscopic repair was significantly less than in open surgery (median 1 dose vs. 3 doses) (Mann-Whitney U test, p=0.03). There was no signif icant difference in the four groups of patients in terms of duration o f nasogastric aspiration, duration of intravenous drip, total hospital stay, time to resume normal diet, visual analogue scale score for pai n in the first 24 hours after surgery, morbidity, reoperation, and mor tality rates. Conclusions Laparoscopic repair of perforated peptic ulc er is a viable option. Sutureless repair is as safe as suture repair a nd it takes less time to perform.