Laparoscopic Surgery for Perforated Duodenal Ulcer Disease: Analysis of 70 Consecutive Cases From a Single Surgeon

초록

Background:In the surgical treatment of perforated duodenal ulcer disease, laparoscopic surgery has become a key technique. However, difficult cases are not eligible for laparoscopic surgery. The purpose of this study was to evaluate the risk factors for postoperative complications and to examine the safety and effectiveness of laparoscopic surgery.Materials and Methods:Seventy duodenal ulcer perforation patients who underwent laparoscopic surgery between July 2010 and March 2014 were reviewed. The type of surgery was chosen on the basis of the size of the perforation. All patients were classified into 2 groups according to the surgical treatment method: primary repair with omentopexy (PR group, n=56) and distal gastrectomy with truncal vagotomy (DG group, n=14).Results:No conversions to open surgery occurred. Three deaths (mortality rate, 4.1%) occurred within 90 postoperative days. Postoperative complications, including 5 severe complications, occurred in 9 patients. There were no differences between the PR and DG groups, except in the mean operation time. In univariate analysis, history of nonsteroidal anti-inflammatory drug use, American Society of Anesthesiologist score (over 3), presence of shock, and time to surgery from symptom onset until surgery (over 48 h) were prognostic factors for postoperative complications. Of particular note, the different perforation sizes were not significantly different. Multivariate analysis showed that history of nonsteroidal anti-inflammatory drug use and treatment delay (48 h) were independent risk factors for overall postoperative complications. The presence of shock on admission was a risk factor for severe postoperative complications.Conclusions:Our results suggest that laparoscopic surgery may be applied to all duodenal ulcer perforations. However, because of the learning period, we believe that laparoscopic surgery may not be suited to every surgeon. However, when performed by laparoscopic experts, laparoscopic surgery can be a valuable approach for treating difficult duodenal ulcer perforations.

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