Background: Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation Laparotomy has been the standard treatment of perforated peptic ulcers. Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer.
Aim and Objectives: To evaluate the efficacy of Omental patch repair versus laproscopic closure of duodenal ulcer.
Materials & Methods: Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. This is a prospective study of patients with perforated duodenal ulcers who underwent laparoscopic repair or open repair. During the study period 53 cases admitted in our surgery emergency and were studied thoroughly according to the prepared proforma, proportions, chi square test and student ‘T’ tests were used to find out the significance.
Results: 53 patients were included in our study.49 patients underwent surgical repair of perforated duodenal ulcer disease (16 laparoscopic repairs and 33 open repairs; mean age - (range, 32-82 years). There was decrease in total operative time in patients who had undergone laparoscopy repair (mean: 67.2 minutes laparoscopic versus 106.8 minutes open), less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (mean time to oral analgesia: 3 days laparoscopic versus 6.78 days open). Wound infection and gaping and burst abdomen were nil in laparoscopic (wound infection 8 cases and burst abdomen 2 cases). There was decrease in recovery without complication in patients who underwent laparoscopic repair (02 complications in lap versus 16 complications in open) and shorter in-patient hospital stay (mean: 4.56 days laparoscopic versus 8.94 days open) and early return to normal activity in patients who underwent laparoscopic repair (mean: 6.44 days laparoscopic vs. 11.48 open).
Conclusion: Therefore laparoscopic repair is almost safe surgical option for patients with perforated duodenal ulcer disease and should be considered for all patients, provided that the necessary expertise is available.