Laparoscopic Management of Duodenal Perforation

AbdulAzeez Karam, MD1, Nourah Alsharqawi, MD2, Salman Alsabah, MD, FRCS, FACS2, Khaled Alsharaf, MD, FRCS1, Ibtesam Albader, MD, FRCS1, Mohammad H Jamal, MD, MEd, FRCS, FACS, FASMBS3. 1Mubarak Hospital, 2Al-Ameeri Hospital, 3Kuwait University Department of Surgery

Introduction: Duodenal perforation is a common acute surgical emergency. The use of laparoscopic management as a method for the treatment of duodenal perforation is gaining ground but is not routine in many centers. In this report we aim to report our experience with laparoscopic repair of duodenal perforation.

Methods: This is a retrospective review of all patients undergoing repair of duodenal perforation between 2009 and 2013. Patient demographics, diagnostic methods, management and outcomes were evaluated.

Results: A total of 67 patients underwent management of duodenal perforation. Diagnosis was established by clinical examination and the presence of pneumoperitoneum in plain abdominal X-rays in 50 patients (75%). 17 patients were diagnosed by CT scans in the absence of x-ray findings. Laparoscopy was attempted initially in 51 patients (76%) and completed in 47 patients (92%). No statistical difference was noted between the open and laparoscopic group in terms of age, socioeconomic class, ASA score, duration of symptoms prior to presentation and comorbidities. However length of hospital stay was shorter in the laparoscopic group (mean =2.6) vs open group (mean=3.1) (P value=0.008). Complications developed in 14 patients (20%) and were no different between the groups. No mortality was identified in this cohort.  In both laparoscopy and open surgery Graham patch repair was performed to the perforated duodenum.

Conclusion: The use of laparoscopy in the treatment of perforated duodenal ulcer is safe and can be utilized as the routine approach for the treatment of this pathology.

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