Laparoscopy May Be Best for Perforated Peptic Ulcer

March 13, 2002

NEW YORK (MedscapeWire) Mar 14 -- Laparoscopic repair of perforated peptic ulcer is as safe and effective as the standard open procedure, according to results of a randomized trial reported in the March issue of the Annals of Surgery.

"When compared with open repair, laparoscopic repair is associated with a shorter operative time, reduced postoperative pain and analgesic requirements, a shorter hospital stay, and earlier return to normal daily activities," write Wing T. Siu, MBChB, FRCSEd, and colleagues from the Pamela Youde Nethersole Eastern Hospital in Chai Wan, Hong Kong.

Of 121 patients with perforated peptic ulcer who were randomized to open or laparoscopic repair, 1 patient died after laparoscopy and 3 patients died after open repair. Surgery took significantly longer in the open repair group. Nine patients had to be converted to an open procedure after laparoscopy.

Relative to the open repair group, the laparoscopic group required significantly less parenteral analgesics and had less postoperative pain. They also had fewer chest infections, but 2 patients developed intra-abdominal collections. Median postoperative stay was 6 days vs 7 days for the open repair group.

"With the demonstrated benefit in our trial, laparoscopic repair of perforated peptic ulcers should be the procedure of choice," the authors write.

Prospective trials are still needed to determine if the laparoscopic approach is safe in patients with generalized peritonitis and if it is advantageous in patients with sepsis, according to an accompanying editorial by Theodore N. Pappas, MD, and Sandhya A. Lagoo, MD, PhD, from Duke University Medical Center.

"It is the surgeon's responsibility to determine the etiology of the disease process in each individual and tailor the subsequent medical management accordingly," they write.

Reviewed by Gary D. Vogin, MD

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