Murad Muhammad Faisal, Khan Rafeya, Tariq Maham, Akram Ayesha, Merrell Ronald C, Zafar Asif
Surgery, Maroof International Hospital, Islamabad, PAK.
Surgery, Holy Family Hospital, Rawalpindi, PAK.
Cureus. 2020 Oct 15;12(10):e10953. doi: 10.7759/cureus.10953.
Background Laparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair. Methods In this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation. Results The mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications. Conclusions Laparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.
背景 近年来，腹腔镜手术正成为大多数腹部手术的金标准。然而，腹腔镜修补十二指肠溃疡穿孔（PDU）仍是一个存在争议的领域。本研究的目的是评估腹腔镜修补PDU与开放修补的安全性和有效性。方法 在这项横断面研究中，对患者进行连续抽样。在一家三级医疗学术医院的101例临床诊断为PDU的患者中，36例接受了腹腔镜格雷厄姆补片修补术，65例接受了开放格雷厄姆补片修补术。开放修补通过上腹部正中切口进行，腹腔镜修补采用三孔技术。计算以下指标：手术时间、术后镇痛持续时间、活动时间以及术后患者住院时间。结果 腹腔镜组的平均手术时间比开放修补组略长（分别为74.01分钟和56.17分钟）。腹腔镜术后平均镇痛需求、活动时间和住院时间均明显短于开放修补术后（分别为1.21天、9.32小时和3.12天，相比之下开放修补组为3.83天、16.20小时和4.85天）。腹腔镜组有3例患者（8%）出现术后并发症，开放修补组有35例患者（54%）出现术后并发症。结论 对于有适当专业水平的医生而言，腹腔镜修补PDU是一种安全的方法，在手术时间、术后镇痛需求、活动情况、住院时间以及术后呼吸和伤口并发症发生率方面均优于开放修补。
