Clinical Study Of Open Versus Laparoscopic Management For Gastroduodenal Perforation

Objectives:Gastric duodenal perforation is a common acute abdomen,and surgery is the main treatment for it.Traditional surgical methods are mostly open surgery.With the popularity of minimally invasive theory,the improvement of endoscopic techniques and the accumulation of experience,laparoscopic gastroduodenal perforation repair is also being used more and more by surgeons.This study was organized to compare the clinical efficacy of laparoscopic and open repair of gastroduodenal perforation,and to provide the impressive surgical method of treatment for gastroduodenal perforation.Methods:A Retrospective analysis study of 174 patients of Subei People's hospital in general surgery department.Which were treated for gastroduodenal perforation.Where 143 cases of patients with open gastroduodenal perforation repair(open group),31 patients underwent laparoscopic gastroduodenal perforation repair(laparoscopic group).For each included patients.The demographic data included age,gender,body mass index(BMI),intra operative measurement included surgery time,intraoperative blood loss,postoperative measurement included time until flatus,hospital stay and post-operative complications were compared and analyzed between these two groups.Result:174 patients were selected in this study.Their ages ranged from 15 to 80 years,which is mainly distributed in the 61-80 years old(n = 88,i.e.,50.57%).Male to female ratio of 4:1.140 were male,i.e.,78.02%while 34 were female,i.e.,21.98%.Most perforations were located on the gastric(n = 121,i.e.,69.54%)with the gastric to duodenal ulcers(n = 53,i.e.,30.46%)ratio of 2.28:1.Laparoscopy were(31,i.e.,17.81%)and open were(143,i.e.,82.18%).The average age of the two groups was(58.8 ± 16.7)and(46.1 ± 18.0 years)respectively,and the distribution of male and female was 114/29 and 26/5,the average BMI was(28.05 ± 4.5kg/m2)and(24.7 ± 3.6kg/m2).There was no significant differences between the two groups regarding demographic data such as age,gender,BMI(p>0.05).Comparing the laparoscopic and open surgery there was a significant different regarding operative time(95 ±25.95min VS 81.03±33.29min,P<0.05);intraoperative bleeding(15.16 ± 13.06ml vs 22.35±25.37ml P<0.05);time until flatus(3.58 ± 0.82 days vs ± 4.411.08 P<0.05);and length hospital stay(9.97 ± 3.56d vs11.64±3.89d P<0.05).In the open surgery group,there are 11 patients developed wound infection,5 patients had ileus,1 patient had leakage,8 patients had sepsis,3 patients had intra-abdominal abscess,and 11 patients had pulmonary infection.While,in the laparoscopic group,there are 2 patients with pulmonary infection,1 patient with wound infection,1 patient with ileus,no patient with leakage,lpatient with sepsis,no patients with intra-abdominal abscess.There was no significant difference in postoperative complications between both groups regarding wound infection,ileus,leakage,sepsis,intra-abdominal abscess and pulmonary infection.Conclusion:Laparoscopic gastroduodenal perforation repair is safe and reliable,has good clinical efficacy,the incidence of complications compared with open surgery does not increase,and has less surgical trauma,less bleeding,advantages of fast recovery of gastrointestinal function and short hospitalization time,Thus it has great clinical significance and should be promoted in surgery.