Open vs laparoscopic repair of perforated peptic ulcer

Background: Most studies have found that the only advantage to the laparosc opic treatment of perforated peptic ulcer is a reduced need for postoperati ve analgesia. Therefore, we set out to assess the short-term outcome of ope n (OR) versus laparoscopic (LR) repair of perforated peptic ulcer. Methods: A total of 62 consecutive OR patients were compared with a concurr ent cohort of 17 diagnosis-marched LR controls treated at the same hospital between 1991 and 1996. Results: The OR and LR patients were comparable for age, weight, American S ociety of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Healt h Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritoniti s Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroida l antiinflammatory drug (NSAID) intake, and previous abdominal surgery. Mor e LR than OR patients were operated on by staff surgeons (chi(2) = 46.9, 1 d.f., p much less than 0.01). Mortality (OR: 12, LR: two), morbidity (OR: e ight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food in take resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, L R: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital sta y (OR: 9 days, LR: 7 days) were not significantly different for the two gro ups. Four LR patients (23.5%) were converted to OR due to failure to progre ss (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p much less than 0.01), LR patients had reduced opioid consumption (256 mg versus 134 mg, p much less than 0.01). O ne LR and 16 OR patients were lost to follow-up. Median follow-up was 14 mo nths (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respe ctively. There were more LR than OR patients with Visick score I (p = 0.002 ) and more OR than LR patients with Visick score II (p = 0.0001). Scores II I and IV did not differ significantly. Conclusion: The laparoscopic repair of perforated peptic ulcer does not yie ld any additional benefits over the open repair.