Article Abstract

Laparoscopic treatment versus open treatment of gastroduodenal perforations: our decades of retrospective experience and literature review

Authors: Salvatore Ragazzi, Raffaele Minardi, Maurizio Carnazza


Background: The aim of our work is to evaluate the laparoscopic treatment of gastroduodenal ul-cers (GDU) perforated in a territory where the population is multiethnic and where, given that the main activity is agriculture, the presence of non-EU citizens (EX) and of Eastern European citizens (EE) is considerably higher.
Methods: From January 2007 to December 2017, 97 patients were operated for perforated GDU in our department all treated within 24 h from admission and/or from the beginning of the sympto-matology, 70 males and 27 females, in most cases they were foreign citizens, the average age was 34 for foreigners and 58 for Italians. In total, 68 were treated by laparoscopy (LS) and 25 by laparoto-my (LT), the cases of conversion from LS to LT were 4 included in a third group. Usual direct su-ture accompanied by omentopexy (OP) if ulcer > of 5 mm and/or if it is in the stomach.
Results: The majority of patients treated were foreign: 69 (24 EX and 45 EE, age: 18–55), while 28 were Italians (age: 30–86). In the foreigners the most frequent cause was alcohol and smoking: pre-sent in 60 patients, in the remaining 9 the cause is abuse of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. In the Italians 21 had abused in NSAIDs and/or corticosteroids and 7 had GD pathologies not treated. The average hospitalization was 6 days for the LS and 9 for the LT and average duration was 91 minutes in LT and 65 in LS.
Conclusions: The gold standard in the treatment of perforated GDU is LS; LS that we can perform in almost all cases treated both because the majority of patients is foreign and has a lower average age compared with Italians and because we have an operating team trained to deal with this disease. 24 h from the symptomatological manifestation has favored us both in terms of endoabdominal col-lections and in the inflammatory state of the perilesional area. In our experience LS treatment is far superior to LT treatment both in terms of patient benefit and health expenditure and combines the advantages of LS with the reliability of LT treatment.