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.