Objective: This study aims to know which access is chosen to operate perforated duodenal ulcer and to evaluate the intra operative and postoperative complications.
Technique: Prospective analysis including all patients admitted with perforated duodenal ulcer. Open treatment is undertaken through midline laparotomy. Laparoscopic treatment is undertaken through 4 trocars. Suture of the ulcer, vagotomy or distal gastrectomy are proposed
Patients: Between 1997 and 2007, 97 patients were included. Diffused pain was found in 53.6% and diffused guarding in 69% of the cases. Ciruculatory failure was found in 34.6% of the cases. Surgery was undertaken under laparoscopy (56.7%), laparoscopy converted to laparotomy (7.2%), through midline laparotomy because of the condition of the patient (26.8%) and because it was the choice of the team (9.3%).
Results: During laparoscopy, 36.4% of the patients had risk factors. Ulcer was sutured in 94.5% of the cases. We observed 7.3% of intra operative complications, 5.5% of admittance in the intensive car unit, 16.7% of postoperative complications and 5.5% of reoperations. During laparotomy, 71.4% of the patients had risk factors. Ulcer was sutured (57.1%), obstructed with the umbilical ligament (2.3%), treated by vagotomy pyloroplasty (7.1%), by vagotomy seromyotomy (21.4%) or by distal gastrectomy (9.5%). We observed 11.9% of intra operative complications, 35.7% of admittance in the intensive car unit, 50% of postoperative complications, 14.3% of reoperations, and 26.2% of death.
Conclusion: Laparoscopy was undertaken in 56.7% of the cases with minimal risk. Because of associated risk factors and the importance of peritonitis, postoperative complications, reoperations and death were more frequent in the cases operated through laparotomy.
Program Number: P243