World Journal of Laparoscopic Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2013 ) > List of Articles


Laparoscopic Management of Perforated Peptic Ulcer in Early and Late Presentation: A Comparative Study

Manash Ranjan Sahoo, T Anil Kumar, Manoj Gowda

Citation Information : Sahoo MR, Kumar TA, Gowda M. Laparoscopic Management of Perforated Peptic Ulcer in Early and Late Presentation: A Comparative Study. World J Lap Surg 2013; 6 (3):116-120.

DOI: 10.5005/jp-journals-10033-1195

Published Online: 01-04-2016

Copyright Statement:  Copyright © 2013; The Author(s).



To compare results of laparoscopic treatment of perforated peptic ulcer (PPU) in early and late presentation.

Materials and methods

Fifty-eight patients of age ranging from 18 to 55 years underwent laparoscopic closure of PPU over a period of 4 years between 2008 and 2011 of which 43 were male, 15 were female. In our study we took early presentation as 3 days and late presentation as 3 to 7 days (time taken for seeking treatment from the onset of symptoms). Thirty-seven presented early whereas other 21 presented late. All patients were compared for variables like operating time, intraoperative complications, risk of anesthesia, rate of conversion to open surgery, postoperative pain and the opiate analgesic requirements, postoperative morbidity and mortality, hospital stay.


Mean operating time for patients with early presentation was 60 vs 90 minutes for delayed presentation. Conversion rate was 0 in early presentation 47.6% (10 cases) in late presentation. Thorough abdominal toileting was possible in all cases of early presentation. In late presentation it was possible only in 6 out of 11 cases after excluding conversion rate because of intestinal matting. No patients had any anesthesia problem in early presentation but 3 out of 11 cases had delayed recovery from anesthesia requiring treatment in intensive care unit. Postoperatively Opioid analgesia was required for mean of 3 days in early presentation vs mean of 4 days in late presentation. Nasogastric tube was removed on 3rd day in early presentation vs 4th day in late presentation which coincided with return of bowel sounds. Port site infection was seen in 5 out of 37 cases in early presentation and 2 out of 11 in late presentation. Intraperitoneal localized abscess was seen in 2 out of 11 cases in delayed presentation and none in early presentation which was then managed by aspiration. Mean hospital stay was 5 days in early presentation and 7 days in late presentation.


Laparoscopic treatment of PPU is safe, feasible done with ease in patients presenting less than 3 days and also in some cases of late presentation, with anesthetic complication, postoperative complications and conversion rate increasing with delayed presentation.

How to cite this article

Kumar TA, Gowda M, Sahoo MR. Laparoscopic Management of Perforated Peptic Ulcer in Early and Late Presentation: A Comparative Study. World J Lap Surg 2013;6(3):116-120.

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  1. Laparoscopic treatment of perforated peptic ulcer. Br J Surg 1990 Sep;77(9):1006.
  2. Laparoscopic repair/ peritoneal toilet of perforated duodenal ulcer. Surg Endosc 1990;4(4):232-233.
  3. Perforated peptic ulcer: open versus laparoscopic repair. Asian J Surg 2002 Oct;25(4):267-276.
  4. Laparoscopic repair of perforated duodenal ulcer. A prospective multicenter clinical trial. Surg Endosc 1997 Oct;11(10):1017-1020.
  5. Changing patterns in perforated peptic ulcer disease. Am Surg 1990 Apr;56(4):270-274.
  6. Perforated peptic ulcer: the changing scene. Dig Dis 1992;10(1):10-16.
  7. Rising frequency of ulcer perforation in elderly people in the United Kingdom. Lancet 1986 Mar;1(8479):489-492.
  8. The current spectrum of peptic ulcer disease in the older age groups. Am Surg 1990 Dec;56(12):737-741.
  9. Peptic ulcer disease in the elderly. Gastroenterol Clin North Am 1990 Jun;19(2):255-271.
  10. Changing trends in perforated peptic ulcer during the past 45 years. Aust N Z J Surg 1992 Sep;62(9):729-732.
  11. Perforated peptic ulcer over 56 years: time trends in patients and disease characteristics. Gut 1993 Dec;34(12):1666-1671.
  12. Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology 1997 May;112(3):683-689.
  13. Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg 1997 May;21(4):412-414.
  14. Treatment of peptic ulcers caused by Helicobacter pylori. N Engl J Med 1993 Feb;328(5):349-350.
  15. Helicobacter pylori in peptic ulcer disease. NIH consensus development panel on Helicobacter pylori in peptic ulcer disease. JAMA 1994 Jul;272(1):65-69.
  16. Antibacterial treatment of gastric ulcers associated with Helicobacter pylori. N Engl J Med 1995 Jan;332(3):139-142.
  17. Emergency operation for gastric duodenal ulcers in high-risk patients. Ann Surg 1986 May;203(5):551-557.
  18. Emergency management of perforated peptic ulcers in the elderly patients. Am J Surg 1984 Dec;148(6):764-767.
  19. Surgical management of perforated peptic ulcer. Ann Surg 1974 May;179(5):628-633.
  20. Perforated gastric ulcer. Postgrad Med J 1985 Mar;61(713):217-220.
  21. Perforated peptic ulcers. JR Coll Surg Edinb 1985 Feb;30(1):26-29.
  22. Perforated gastric ulcers. A plea for management by simple closure. Arch Surg 1988 Aug;123(8):960-964.
  23. Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br J Surg 1990 Jan;77(1):73-75.
  24. The sixth decision regarding perforated duodenal ulcer. JSLS 2002 Oct-Dec;6(4):359-368.
  25. 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 Jan;33(1):80-85.
  26. Perforated duodenal ulcers. World J Surg 1987 Jun;11(3):319-324.
  27. Comparison of laparoscopic versus open repair for perforated duodenal ulcers. Surg Endosc 2005 Dec;19(12):1565-1571.
  28. Laparoscopic repair of perforated duodenal ulcers: Outcome and efficacy in 30 consecutive patients. Arch Surg 1999 Aug;134(8):845-848.
  29. A logical solution to the perforated ulcer controversy. Surg Gynecol Obstet 1980 May;150(5):683-686.
  30. What has happened to perforated peptic ulcer? Br J Surg 1984 Oct;71(10):774-776.
  31. Laparoscopic treatment of peptic ulcer disease. In: Hunter JG, Sackie JM, editors. Minimally invasive surgery. New York. McGraw-Hill. 1998;123-130.
  32. Systematic review comparing laparoscopic and open repair for perforated peptic ulcers. Br J Surg 2005 Oct;92(10):1195-1207.
  33. Laparoscopic repair of perforated peptic ulcer. Br J Surg 1995 Jun;82(6):814-816.
  34. Preliminary results of laparoscopic repair of perforated duodenal ulcers. Surg Laparosc Endosc 1993 Jun;3(3):161-163.
  35. A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 1996 Aug;224(4):131-138.
  36. Sutureless laparoscopic treatment of perforated duodenal ulcer. Br J Surg 1993 Feb;80(2):235.
  37. Therapeutic laparoscopy. Endoscopy 1992 Jan-Feb;24(1-2):138-143.
  38. Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler. Br J Surg 1993 Dec;80(12):1552.
  39. Coelioscopic treatment of perforated gastroduodenal ulcer using ligamentum teres hepatis. Surg Endosc 1991;5(3):154-155.
  40. Laparoscopic repair of perforated peptic ulcer. Br J Surg 1993 Sep;80(9):1212.
  41. Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH). Surg Endosc 1995 Jun;9(6):677-680.
  42. Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat. Surg Endosc 1995 Aug;9(8):898-901.
  43. Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxemia in an animal model of peritonitis. Br J Surg 1995;82(6):844-848.
  44. Laparoscopic repair of perforated peptic ulcers. The role of laparoscopy in generalised peritonitis. Ann R Coll Surg Engl 2000 Jan;82(1):6-10.
  45. Laparoscopic and conventional closure of perforated peptic ulcer. A comparison. Surg Endosc 1996 Aug;10(8):831-836.
  46. Management strategies, early results, benefits and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg 2005 Oct;29(10):1299-1310.
  47. Laparoscopic repair of perforated peptic ulcer with delayed presentation. J Laparoendosc Adv Surg Tech A 2009 Apr;19(2):153-156.
  48. A randomized comparison of acute phase response and endotoxemia in patients with perforated peptic ulcers receiving laparoscopic or open patch repair. Am J Surg 1998 Apr;175(4):325-327.
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