Laparoscopic suture repair of perforated duodenal peptic ulcer for patients without risk factors.

Background: Suture repair became the standard treatment for perforated duodenal ulcer (PDU) due to the efficacy of modern anti-ulcer therapy. This study compared short-term outcomes of open versus laparoscopic suture repair of PDU in patients without risk factors.

Method: Patients with perforated duodenal ulcer were selected for open or laparoscopic suture repair. Patients with either one or more of the following risk factors were excluded: age > 50 years, interval between perforation and operation > or = 12 hours, presence of major comorbidities (American Society of Anesthesiologists [ASA] III-IV), and previous abdominal surgery.

Results: 174 patients underwent open surgery (OSG) and 85 underwent laparoscopic surgery (LSG). The two groups were similar in regard to age, sex, ulcer disease history, time between onset of surgery, ASA score, and presence of free air on X-ray. There were statistical differences between OSG and LSG in the duration of operating time (55 vs 85 min), analgesic doses (16 vs 9) and hospital stay (7.8 vs 6.1 days). During the night (10:00 PM - 06:00 AM), 129 patients were operated: 107/174 in OSG and 22/85 in LSG. In LSG we performed suture repair in 37 patients and suture repair with omental patch in 41 patients. In OSG, 7 patients had a wrong preoperative diagnosis of acute appendicitis. Five patients (5.8%) in LSG group and 15 patients (8.6%) in OSG had postoperative complications and 2 respectively 1 patient needed reoperation. The two reoperated patients in LSG presented suture repair leak and a right subphrenic abscess. Both had only suture repair. There were no mortalities.

Conclusion: We believe that suture repair with omental patch associated with anti-ulcer medical therapy is the standard therapeutic solution in PDU for young patients without risk factors.