Published: 2017-05-24

Laparoscopic and open repair of perforated peptic ulcer

Ahmed Abdel Monem Ibrahim, Backeet Turkeyev, Mohammad Mahmood Al Alkatary


Background: The study included patients diagnosed as perforated peptic ulcer. Outcomes are assessed by mortality and morbidity rate, operation time and hospital length of stay.

Methods: On the period from January 2013 to December 2014 a total of 71 patients were operated in both facilities: 37 patients in Dubai hospital and 34 in Mafraq Hospital. Open repair with omental patch done in 34 patients (47.9%) and laparoscopically in 37 patients (52.1%). No cases of laparoscopy converted to laparotomy.

Results: The data demonstrates homogeneous results for the outcome variables of morbidity and complications, while operation time and hospital length of stay differ significantly. Statistical significance could not be reached for any of these variables, although odd ratios were consistently in favour of the laparoscopic repair. Similarly, the laparoscopic approach resulted in a lower rate of minor complications (10% vs. 23%). Total lengths of stay post open repair made of 4.2±1.2 days, after laparoscopic repair 3.6±0.9 days. At the same time there were observed longer operating times for laparoscopic repair of PPU which constituted 62±10.6 minutes whereas open repair took only 45±12.9 minutes. Peritoneal lavage has been a factor of prolonged duration of laparoscopic surgery.

Conclusions: Laparoscopic repair of a perforated peptic ulcer is an amenable and feasible technique within the hands of experienced laparoscopic surgeon. Current evidence does not clearly demonstrate the advantages of laparoscopic versus open repair. Growing interest in the laparoscopic approach may encourage the design of additional randomized trials to analyze its efficacy compared with the open approach.


Laparoscopic and open repair of perforated peptic ulcer, Ulcer

Full Text:



Seelig MH, Seelig SK, Behr C, Schonleben K. Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers. J Clin Gastroenterol. 2003;37:201.

Siu WT, Chau CH, Law BK, Tang CN, Ha PY, Li MK. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg. 2004;91:481-4.

Larkin JO, Bourke MG, Muhammed A, Waldron R, Barry K, Eustace PW. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study. Irish J Med Sci. 2010;179:545-9.

Sartelli M, Viale P, Catena F. WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):3.

Bertleff MJ, Halm JA, Bemelman WA. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA trial. World J Surg. 2009;33(7):1368-73.

Siu WT, Leong HT, Law BK. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235(3):313-9.

Bhogal RH, Athwal R, Durkin D, Deakin M, Cheruvu CN. Comparison between open and laparoscopic repair of perforated peptic ulcer disease. World J Surg. 2008;32(11):2371-4.

Lunevicius R, Morkevicius M. Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. British J Surg. 2005;92(10):1195-207.

Domínguez-Vega G, Pera M, Ramón JM, Puig S, Membrilla E, Sancho J, et al. A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers. Cirugía Española (English Edition). 2013;91(6):372-7.

Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg. 2005;29(10):1299-310.

Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg. 2014;101:e51-64.

Mouret P, François Y, Vignal J, Barth X, Lombard-Platet R. Laparoscopic treatment of perforated peptic ulcer. Br J Surg. 1990;77:1006.

Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33(1):80-5.

Simone G, Ismail C, Christian G. Laparoscopic repair of perforated peptic ulcer: single-center results. Surg Endosc. 2014;28:2302-8.

Katkhouda N, Mavor E, Mason RJ, Campos GM, Soroushyari A, Berne TV. Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg. 1999;134(8):845-50.