Laparoscopy versus laparotomy in the surgical treatment of perforated duodenal ulcers

Background: There is no clear consensus about whether laparoscopy or laparotomy is more beneficial in managing perforations of duodenal ulcers. Objective: The study was performed to compare between laparotomy and laparoscopic approaches in managing perforations of duodenal ulcers regarding operative time and early operative outcomes. Patient and methods: This randomized comparative prospective study included 84 cases diagnosed with perforated duodenal ulcer, they were divided into two equal groups: laparotomy and laparoscopic groups (42 cases for each). All cases were clinically and radiologically assessed. Operative time was our primary outcome, while secondary outcomes included post-operative pain, analgesic consumption, hospitalization time, and complications of both techniques. Results: No significance in differences were reported between the two groups regarding patient demography. Both smoking history and analgesic use were reported by most cases in both groups. The operative time (p = 0.082) was not significantly different between the two groups. The laparoscopic group showed less pain scores, less morphine needs, earlier oral fluid intake, and short hospitalization time in comparison to the laparotomy group. Also, the wound infection incidence was significantly higher in the laparotomy group. Conclusion: The laparoscopic approach appears to be more safe and efficacious in the surgical treatment of perforations of duodenal ulcers, as it is associated with less peri-operative complications and shorter hospitalization time with a comparable operation time in comparison to laparotomy.