Objectives : The present rtudy aimed to determine the operative yield of laparoscopic repair of perforated
• duodenal ulcer (DU) and to e-nduate 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 omen tal patch
and were followedrup 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 with calculated. Ulcer size, duration of operation, conversion, reason for conversion and duration
of nasogastric suction, time till resumption of °refill:id 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 IVO 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 nasogastric tube 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. Cue patient (ASA class IV) developed acute myocardial infarction
and died on the 4th PO day (Mortality rate3.3%) and 3 patients developed PO complications (PO morbidity
rate 10%). Analysis of evaluated parantetets 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
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%, respecttly.
Components of Beery risk factors were found to be specific predictors for PO morbidity and mortality in patients
with perforated DU. |
