Laparoscopic repair of perforated peptic ulcers in children: a 10-year experience from a single tertiary pediatric hospital

Perforated peptic ulcer (PPU) is rare in the pediatric population. This study describes a single tertiary pediatric hospital's experience in the laparoscopic repair of PPU in children and to identify potential factors that may influence the decision to convert to open surgery. A retrospective database study was performed on all cases of perforated gastric and duodenal ulcers that underwent surgical repair between 2012 and 2022. Patient demographics, clinical presentation, pre-operative investigations, operative details and post-operative outcomes were analysed. In addition, a literature review of articles describing or comparing the outcomes of laparoscopic versus open repair of PPU in children was performed. A total of 12 patients underwent surgical repair for PPU. All patients received a laparoscopic-first approach (LS) with 4 patients (33%) requiring a conversion to open surgery (COS). The median age at presentation was 13.5 years with a predilection for male gender. Most presented with abdominal pain (91.7%) without known risk factors or history of peptic ulcer disease. 9 out of 12 perforations were in the duodenum and located anteriorly. The reasons for COS were the need for better visualization or localization of the site of perforation. The LS group had a faster return of bowel movement. Younger age (4 vs. 14 years old; p=0.05), lower BMI (13.9 vs. 22.1 kg/m2; p=0.01), delayed presentation from symptom onset (42.5 vs. 3.3 hrs; p=0.01), higher CRP level (134.1 vs. 2.7 mg/L; p=0.05) and lower platelet count (306 vs. 349 cells/uL; p=0.04) were associated with conversion to open surgery. A high index of suspicion is required for the diagnosis of PPU in the pediatric population. It is encouraging from the results in the literature and in our study that laparoscopic repair for PPU in the pediatric population seems feasible and safe with good post-operative recovery and clinical outcomes.