Comparative study between laparoscopic and open omentoplasty repair of perforated duodenal peptic ulcer

Background: Laparoscopic treatment of perforated peptic ulcers is still a matter of discussion; some authors propose laparoscopy in most patients even in high risk cases while others use strict policy for patient selection for laparoscopy and large number of surgeons refuse it.Aim of the study: Comparison between outcomes of laparoscopic and open approaches to detect advantages of laparoscopy over laparotomy.Materials and Methods: Comparative non-randomized study done on 24 patients with perforated duodenal ulcer, group A (16 patients) had laparoscopic omentoplasty and group B (8 patients) underwent laparotomy.Results: All patients were males except one, mean age was significantly higher in laparotomy group. Risk factors for perforation as ulcer symptoms as smoking, NSAID long-term use were positive in most patients. Air under diaphragm in X-ray was positive only in 87.5% of patients. Mean operative time was significantly shorter in group A while mean blood loss was insignificantly less in laparoscopy. 3 patients in laparoscopy group were converted to laparotomy. Mean hospital stay was significantly shorter in group A. 4 patients (25%) in group A reported postoperative complications, 2 patients were re-operated. In group B, 5 patients (62.5%) showed complications, 2 patients were re-explored and one case of mortality due to septic shock. No mortality reported after laparoscopy. Laparoscopy group reported success rate of 68.75%. Conclusion: Laparoscopy perforated peptic ulcers had shorter operative time, less hospital stay and fewer complications than laparotomy so, it could be used in selected patients. However, larger studies are required to assess outcomes.