Mortality and Morbidity in Peptic Ulcer Perforation: A Comparison between Radical Open Repair vs Conservative Laparoscopic Repair

Abstract

Introduction: Currently, in the era of robotic surgery and advancement of laparoscopic technology, the place of open surgery has been reduced. However, the use of laparoscopic surgery for peptic ulcer disease is not yet a consensus. Materials and methods: All patients who had been operated for perforated peptic ulcer (PPU) disease from January 2005 to December 2014 in our hospital were reviewed retrospectively. Patient demographics, perioperative and intraoperative details, and surgical outcomes were evaluated. The objective of our study is to compare the clinical and surgical outcomes of patients who underwent either laparoscopic or open procedure as well as to demonstrate if laparoscopic repair (LR) technique has advantages to open repair (OR) in terms of morbidity and mortality. Results: We diagnosed 159 patients with PPU during the study period. LR was performed for 65 (41%) patients, and the remaining patients underwent OR. Morbidity of medical and surgical complication was higher in open groups (21 vs 2) ( p value = 0.0001). The most frequent complication in both groups was medical complication. Overall, 16 patients in the OR group had medical complications vs 2 patients in the LR group ( p value = 0.009). Surgical complication was higher in open groups (7 vs 0) ( p value = 0.04). Mortality was statistically higher in the open group. We did not report any death in the laparoscopic group. However, six deaths were identified in the OR group ( p value = 0.04). Conclusion: Our results indicate that LR for PPU was a safety option with fewer rates of morbidity, reoperation, and mortality compared to OR.