PEPTİK ÜLSER PERFORASYON ONARIMINDA LAPAROSKOPİNİN YERİ NEDİR? What Is The Place Of Laparoscopy In Perforated Peptic Ulcer Repair?

OZET Amac: Bu calismadaki amacimiz, peptik ulser perforasyonunda (PUP) uygulanan laparoskopik onarim (LO) ile acik onarimin (AO) avantajlari ve komplikasyonlarini belirleyerek, LO’in PUP’ndaki etkinligi ve guvenirligini degerlendirmekti. Gerec ve Yontemler: Klinigimizde Ocak 2010 ile Ekim 2019 tarihleri arasinda PUP nedeniyle ameliyat edilen hastalarinin kayitlari da retrospektif olarak degerlendirildi. Kanamali ulseri olanlar ve iatrojenik perforasyonu olanlar calisma disi birakildi. Calismaya, PUP nedeniyle LO uygulanan 23 hasta ve AO uygulanan 34 hasta olmak uzere toplam 57 hasta dahil edilmistir. Hastalar LO grubu ve AO grubu olmak uzere 2 gruba ayrildi. Tum hastalara ait demografik veriler, operasyon oncesi lokosit sayisi ve ASA (American Society of Anesthesiologists) skoru, operasyon tipi, operasyon suresi, ulser yerlesim yeri, ulser capi, operasyona bagli komplikasyon durumu, operasyona bagli cerrahi disi komplikasyon durumu ve hastanede kalis suresi kayit altina alindi. Bulgular: Calismamizda iki grup arasinda yas, cinsiyet, preoperatif donemde belirlenen ASA skoru ile preoperatif donemdeki lokosit sayisi acisindan istatistiksel fark tespit edilmemistir (sirasiyla p=0,078, p=0,393, p=0,106, p=0,104). Ulser yerlesim yeri acisindan da iki grup arasinda istatistiksel fark belirlenmezken; ulser capinin LO grubunda istatistiksel olarak anlamli derecede daha yuksek oldugu gosterilmistir (sirasiyla p=0,313, p=0,005). Operasyon suresi ve hastanede kalis suresinin LO grubunda anlamli olarak kisa oldugu belirlenmistir (sirasiyla p=0,002, p<0,001). Ayrica genel komplikasyonlarin ve yara yeri enfeksiyonunun LO grubunda istatistiksel olarak anlamli derecede daha az oldugu gosterilmistir (sirasiyla p=0,031, p=0,033). Sonuc: Calismamizda ortaya cikan sonuclar goz onunde bulunduruldugunda, PUP onariminda laparoskopik yaklasimin guvenle ve etkili bir sekilde uygulanabilecegini dusunuyoruz. Anahtar Kelimeler: Peptik Ulser; Perforasyon; Laparoskopi; Akut Abdomen ABSTRACT Objective: The aim of this study was to evaluate the efficacy and safety of laparoscopic repair (LR) in perforated peptic ulcer (PPU) by determining the advantages and complications of LR and open repair (AR) in PPU. Material and Methods: The records of patients who were operated for PPU between January 2010 and October 2019 were evaluated retrospectively. Patients with hemorrhagic ulcers and those with iatrogenic perforation were excluded from the study. A total of 57 patients, 23 patients undergoing LR and 34 patients undergoing AR, were included in the study. Patients were divided into two groups as LR group and AR group. All patients' demographic data, preoperative leukocyte count and ASA (American Society of Anesthesiologists) score, type of operation, operation duration, ulcer location, ulcer diameter, operation-related complications, operation-related non-surgical complications and length of hospital stay were recorded. Results: In our study, no statistically significant difference was found between the two groups in terms of age, gender, preoperative ASA score and preoperative leukocyte quantity (p=0.078,p=0.393,p=0.106,p=0.104, respectively). There was a statistical difference between the two groups in terms of ulcer location; but ulcer diameter was significantly higher in LR group (p=0.313,p=0.005,- respectively). The duration of operation and length of hospital stay were significantly shorter in the LR group (p=0.002,p<0.001,respectively). In addition, overall complications and wound infection were shown to be significantly lower in the LO group (p=0.031,p=0.033,respectively). Conclusion: Considering the results in our study, we think that laparoscopic approach can be applied safely and effectively in the repair of PPU. Keywords: Peptic Ulcer; Perforation; Laparoscopy; Acute Abdomen