Laparoscopic Repair for Perforated Peptic Ulcer: A Randomized Controlled Trial

Peptic ulcer perforation is a common surgical emergency and a major cause of death in elderly patients. 1,2 There is, however, disagreement as to the relative merits of nonoperative treatment, simple closure, or a definitive acid-reduction procedure for perforated peptic ulcers. Nonoperative treatment of perforated peptic ulcers was shown to be effective. 3 However, the uncertainty in diagnosis, the potential delay for treatment in nonresponders, and the unreliable response in elderly patients make it difficult to be applied to all clinical situations. In the past two decades, there has been a change in the pattern of perforated peptic ulcer disease in affecting old and infirm patients, with a high association with nonsteroidal antiinflammatory agents. 4–11 They seldom require any definitive procedure, which is associated with increased rates of perioperative death and complications. 12Helicobacter pylori is now the recognized culprit of the majority of patients with duodenal and gastric ulcers, and posteradication ulcer recurrence is uncommon. 13–15 Acid-reduction procedures are not required for this group of patients. As a result, simple closure of the perforation with an omental patch has become the favored management approach in many institutions. It is technically straightforward and reliable and is also the preferred approach for high-risk patients. 16–22 Laparoscopic cholecystectomy has become the standard procedure for removal of diseased gallbladder, superseding open cholecystectomy because it reduces pain, the wound complication rate, and the length of hospital stay. 23 The advantages of laparoscopic repair of perforated peptic ulcers are less apparent. We conducted a randomized trial to compare the outcome of laparoscopic and open omental patch repair for perforated peptic ulcers.