Laparoscopic Repair Of Perforated Duodenal Ulcer: Evaluation Of Outcome and Risk Factors
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Objectives : The present study aimed to determine the operative yield of laparoscopic repair of perforated • duodenal ulcer (DU) and to evaluate the predictive value of various risk factors for the oncoming postoperative (PO) complications. Patients & Methods : The study included 30 patients; 26 males and 4 females with mean age of 48.2±8.4 years; 12 patients had history of peptic ulcer disease. Diagnosis of perforated DU was based on clinical presentation and investigations. All patients underwent laparoscopic repair with application of omental patch and were followed-up for 6 PO Months. Patients' assessment included age, gender, ASA grade, presence of shock on admission, peritonitis, and duration of ulcer perforation. Boey score-risk factors were evaluated and collective score waS calculated. Ulcer size, duration of operation, conversion, reason for conversion and duration of nasogastric suction, time till resumption of oral fluid and duration of hospital stay were analyzed. Results: Total Boey score was 0, 1 and 2 in 23, 5 and 2 patients, respectively with predicted PO mortality of 0%, 0-10% and 10-46%, respectively. Mean perforation size was 5.1±2.8; range: 1.5-12 mm, mean operative time was 51.5±7.6; range: 45-75 minutes. Laparoscopic repair was completed in 27 patients (90%) and there were 3 conversions (10%). No PO narcotic analgesia was required in 14 patients, 11 patients requested pethidine once and 5 patients requested pethidine twice. Mean duration of nasogastriciube suction was 2.6±0.9; range: 2-5 days and mean time till resumption of oral intake was 3.4±0.8; range: 2-5 days. Mean duration of PO hospital stay was 5.6±1.1; range: 4-8 days. One patient (ASA class IV) developed acute myocardial infarction and died on the 4th PO day (Mortality rate=3.3%) and 3 patients developed PO complications (PO morbidity rate 10%). Analysis of evaluated parameters and obtained data as predictors of PO morbidity using ROC curve analysis revealed that total Boey score and delayed presentation with prolonged duration of acute pain were the factors most significantly affecting the possibility of occurrence of PO morbidity and mortality. Conclusion: Laparoscopic repair of perforated DU is an effective therapeutic modality with technical success rate of 90% and safe with postoperative morbidity and mortality rates of 10% and 3.3%, respectitely. Components of Boey risk factors were found to be specific predictors for PO morbidity and mortality in patients with perforated DU.