Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers.

摘要

GOALS: The aim of this study was to evaluate our results of laparoscopic treatment of perforated gastroduodenal ulcers during a 5-year period and to compare the outcome of open and laparoscopic surgery. BACKGROUND: The value of laparoscopic treatment of gastroduodenal ulcers is still controversially debated because its superiority to conventional open surgery has not been established. STUDY: From January 1996 to December 2001, 24 patients were treated laparoscopically and 31 patients underwent conventional open suture repair. The results of these patients were retrospectively reviewed. RESULTS: There were 55 patients with a mean age of 55 years (range 18-92 years) who were eligible for the study. Patients with laparoscopic repair had a lower mean ASA score (2 vs. 2.9; P = 0.02) and a less severe Mannheimer peritonitis index (16.5 vs. 21; P = 0.00001) compared with patients with open repair. Three patients who were begun by the laparoscopic approach had to be converted to open surgery (12.5%). Three patients who underwent open repair died postoperatively (5.5%). There was no difference between treatment groups regarding operative time, morbidity, or postoperative hospital stay. The laparoscopic group required significantly fewer analgesics postoperatively (2.2 vs. 4 dosages; P = 0.04). CONCLUSIONS: Laparoscopic treatment of perforated gastroduodenal ulcers is an effective treatment option and should be considered in suited patients for the initial approach.