Laparoscopic repair versus open repair for perforated peptic ulcers
Is figure of eight suture safe?
Aim : Recent meta-analysis comparing laparoscopic repair and repair with open method were indecisive about the preference of a certain method. The aim is to compare the results of our patients who have undergone laparoscopic or open PUP repair and to investigate if it’s safe to close PUP area by easy-to-apply figure of eight suture. Material and method: The patients who were operated laparoscopically or by open method for peptic ulcus perforation between June 2012 and December 2018 were included in this retrospective study. Omentoplasty was done after the primary repair of PUP focus in open method cases. Omentoplasty was done by figure of eight suture in laparoscopic cases. The age and sex of the patients, type of operation, duration of operation, follow up period, duration of hospital stay, time to return to normal activities, post-op early and late complications were examined. Exclusion criteria was as follows: Iatrogenic perforations, traumatic perforations, perforations with bleeding, ASA IV patients, late cases who were symptomatic >24 hours, patients with a perforation focus >1 cm. Results: A total of 49 patients were included into study; 42 of them were male (85,7%) and 7 female (14.3%). Laparoscopy was used in 27 patients (55.1%) and open method in 22 (44.9%). In 3 patients (6.1%) wound site infection, in 1 patient (2.1%) subileus, in 1 patient (2.1%) incisional hernia, in 1 patient trocar site (2.1%) hernia have been observed. Wound site infection, subileus, incisional hernia and trocar site hernia were compared according to the type of operation and there was no significant difference. Duration of hospital stay (4,7±1,2 days) was shorter with laparoscopic method compared to open method (6,1±1,3 days) (p=:0,001). Similarly, by laparoscopic method return to work (11,30±1,75 days) was shorter than open method (20,59±2,42 days ) (p<0,001).. Conclusion:
Laparascopic PPU treatment is a safe method. It can be applied safely with easy-to-apply figure of eight suture in uncomplicated cases.
Keywords: Laparoscopicrepair, Perforatedpepticulcer, Simple closure