Laparoscopic Versus Open Repair Of Gastroduodenal Ulcer Perforation

Background: In recent years, the incidence of gastroduodenal ulcer perforationshowed a growing and younger trend. Surgical repair is still the preferred treatment.Laparoscopy is widely applied in clinical practice, with improvement of instrument andsurgical techniques, and innovation of methods. Previous studies have reported thatcompared with open repair of peptic ulcer perforation, laparoscopic repair was lessinvasive and recovered faster, with a low complication rate. However, the detailedinfluence of laparoscopic repair for perforated peptic ulcers and main mechanisms remainsunknown.Objective：To evaluate the influence of laparoscopic versus open repair for perforatedpeptic ulcers and the main mechanisms.Methods： Fifty-eight patients with peptic ulcer perforation in gastroinstestinaldepartment of Yancheng Third People’s Hospital were enrolled in our study from August2008to May2013, including30patients treated with laparoscopic repair and28patientswith open repair. Clinical data of patients in two groups were analyzed retrospectively.Compare the operative time, blood loss, pain score, recovery time of intestinal function,using time of postoperative antibiotic, hospitalization time and costs, and complicationrates between two groups. Simultaneously, white blood cell count (WBC), percentage ofnetrophil cells (NEU%), platelet count (PLT), and plasma levels of C-reactive protein(CRP) were measured in all patients before and at the postoperative day1,3and5, as wellas prothrombin time (PT), total bilirubin (TBI), blood urea nitrogen (BUN) and creatinine(Cr). The enzyme-linked immunosorbent assay (ELISA) was used for interleukin-6(IL-6)and tumor necrosis factor-α (TNF-α) determination, and the flow cytometry was adoptedfor T-lymphocyte subpopulation counting.Results：1) Statistical analysis of clinical data revealed that laparoscopic perforation repair had more benefits than open perforation repair in recovery time of intestinal function,hospitalization time, using time of postoperative antibiotic, and so on.2) Levels of inflammatory markers in patients who underwent laparoscopicperforation repair, such as WBC and CRP, were significantly lower than that in patientswho underwent open perforation repair.3) The results of ELISA showed that serum levels of inflammatory factors IL-6andTNF-α were dramatically lower in patients in laparoscopic repair group, compared withthat in open repair group.4) The results of flow cytometry revealed that laparoscopic foration repair influencedthe distribution of T-lymphocyte subpopulation more than open foration repair, anddemonstrated that cellular immune status of patients in laparoscopic repair group was morestable and better than that in the open repair group.Conclusion：Laparoscopic repair of gastroduodenal ulcer perforation was considered as a safe andeffective method, and worth to be used in clinical practice, because of minor trauma to thebody, less influences on organs and inflammatory reactions, fewer complications, and moreconductive to the rehabilitation of patients.