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Ten-Year Retrospective Comparative Analysis of Laparoscopic Repair versus Open Closure of Perforated.

BACKGROUND
Aim of this study was to compare the result of open and laparoscopic repair of perforated peptic ulcers in terms of operation time, postoperative pain, hospital stay, and wound infection.


METHODS
Clinical notes of 152 patients who underwent the operative closure of perforated peptic ulcers from 1996 to 2006 were available for study. All patients were offered laparoscopic approach from 1998 onward. Repair was done using omentum patch. Open approach was used in 57 patients and laparoscopic in 95 patients. Results were analyzed in terms of requirement of analgesia, hospital stay, return to work, complications, and mortality.


RESULTS
Closure was successful in all cases using omentum patch. There was no conversion to open in laparoscopic group. The mean operation time was less in laparoscopic versus open (P<0.001). The mean number of analgesic injection given were 3 and the hospital stay was 4 days in laparoscopy, the corresponding figure in laparotomy were 6 and 9 respectively (P<0.001). Total numbers of complication in laparoscopic repair were 9 compared to 35 in open (P=0.011). Two patients died in each group. Incidental significant incidences of perforations was observed in men (P<0.001), fasting during Ramadan (P<0.001), smokers (P<0.001), past history of peptic ulcer disease (P=0.007), and use of non-steroidal anti-inflammatory drugs (P=0.035).


CONCLUSION
Compared to open approach, laparoscopic repair required shorter operation time, lesser analgesia, had fewer complications, shorter hospital stays and early return to work.