Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Introduction: Laparoscopic repair of perforated peptic ulcer (PPU) remains controversial mainly due to its safety and applicability in critically ill patients. The aim of this study is to compare the outcomes of laparoscopy versus laparotomy in the treatment of PPU.

Methods: Single-institutional, retrospective study of all patients submitted to surgical repair of PPU between 2012 and 2019.

Results: During the study period, 169 patients underwent emergent surgery for PPU. A laparoscopic approach was tried in 60 patients and completely performed in 49 of them (conversion rate 18.3%). The open group was composed of 120 patients (included 11 conversions). Comparing the laparoscopic with the open group, there were significant differences in gender (male/female ratio 7.2/1 versus 2.2/1, respectively; p=0.009) and in the presence of sepsis criteria (12.2% versus 38.3%, respectively; p=0.001), while the Boey score showed no differences between the two groups. The operative time was longer in the laparoscopic group (median 100' versus 80', p=0.01). Laparoscopy was associated with few early postoperative complications (18.4% versus 41.7%, p=0.004), mortality (2.0% versus 14.2%; p=0.02), shorter hospital stay (median 6 versus 7 days, p=0.001), and earlier oral intake (median 3 versus 4 days, p=0.021).

Conclusion: Laparoscopic repair of PPU may be considered the procedure of choice in patients without sepsis criteria if expertise and resources are available. This kind of approach is associated with a shorter length of hospital stay and earlier oral intake. In patients with sepsis criteria, more data are required to access the safety of laparoscopy in the treatment of PPU.