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Medicina (Kaunas) 2004; 40 (6): 522-537
Perforated duodenal ulcer: benefits and risks of laparoscopic repair
Raimundas Lunevičius, Matas Morkevičius
Clinic of General and Vascular Surgery, Vilnius University, Center of General Surgery, 2nd Department of Abdominal Surgery, Vilnius University Emergency Hospital, Lithuania
Key words: perforated duodenal ulcer, laparoscopic repair, complications, risk factors.
Summary. Objective. Laparoscopic perforated duodenal ulcer repair is a minimally invasive technique. Just like any other type of surgery, the laparoscopic approach carries operative risks in itself. The primary goal of this article is to describe the possible risk factors in laparoscopic duodenal ulcer repair. The secondary goal is to clarify benefits of the laparoscopic surgery. Material and methods. The Medline/Pubmed database was used; 73 articles were analyzed and evaluated. Results. Six retrospective and nine prospective studies are summarized. The retrospective studies’ results are as follows: total complication rate is 7–28% (average – 16%); conversion rate is 6–30% (average – 18%); postoperative mortality rate is 0–20% (average – 6%); and average hospital stay is 6–17 days (average – 8 days). The results of the prospective studies are the following: total complication rate is lower – 5–25% (average – 11%); conversion rate is lower – 0–27% (average – 14%); postoperative mortality is lower 0–10% (average – 3%); and average hospital stay is shorter – 4–10 days (average – 6 days). The difference is not significant but the results are better than in prospective studies. The risk factors were identical. Conclusions. Shock, delayed presentation (>24 hours), confounding medical condition, age >70 years, American Society of Anesthesiology III–IV° and Boey score – all above should be considered as preoperative laparoscopic repair risk factors. Inadequate ulcer localization, large perforation size (>6 mm diameter according to ones, >10 mm according to others) and ulcers with friable edges are also considered as laparoscopic repair risk factors: each of the factors independently is an indication for an open repair.
Correspondence to R. Lunevičius, 2nd Department of Abdominal Surgery, Vilnius University Emergency Hospital, Šiltnamių 29, 04129 Vilnius, Lithuania. E-mail: rlunevichus@yahoo.com
Received 2 December 2003, accepted 14 May 2004