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Outcome and Efficacy in 30 Consecutive Patients

Namir Katkhouda, MD; Eli Mavor, MD; Rodney J. Mason, MD, PhD; Guilherme M. R. Campos, MD; Ardeshir Soroushyari, MD; Thomas V. Berne, MD

Arch Surg. 1999;134:845-850.

Hypothesis  Laparoscopic management of perforated duodenal ulcers is safe and effective.

Design  Prospective nonrandomized controlled trial.

Setting  Tertiary care academic center.

Patients and Methods  Between October 1993 and October 1997, 30 patients underwent laparoscopic Graham patch repair of perforated duodenal ulcers and 16 had an open repair.

Main Outcome Measures  Morbidity, operating time, analgesic requirements, length of hospital stay, and time to return to work.

Results  There was no difference in morbidity between the 2 groups. Operating time was longer in the laparoscopy group (106 vs 63 minutes; P=.001). Patients with shock on admission or symptoms for more than 24 hours had a higher conversion rate (P<.05). The laparoscopy group required fewer analgesics, had a shorter stay, and a quicker recovery.

Conclusions  Laparoscopic repair for perforated ulcers is safe and maintains benefits of the minimally invasive approach. Laparoscopy is not beneficial in patients with shock.

From the Division of Emergency Non-Trauma and Minimally Invasive Surgery, Department of Surgery (Drs Katkhouda, Mavor, Mason, Campos, and Soroushyari), and the Division of Trauma Surgery, Department of Surgery (Dr Berne), University of Southern California School of Medicine, Los Angeles.

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