Laparoscopy First Approach in Acute Care Surgery

The use of laparoscopic management as a first choice for the treatment of duodenal perforation is gaining ground but is not routine in many centers. In this report we aim to report our experience with laparoscopy as the first approach for the repair of duodenal perforation. This is a retrospective review of patients during our initial experience with the use of laparoscopy for the treatment of duodenal perforation between 2009 and 2013. A total of 100 patients underwent management of duodenal perforation. Laparoscopy was attempted initially in 76 patients (76%) and completed in 64 patients (64%). The length of hospital stay was shorter in the laparoscopic group (mean =2.6) vs open group (mean=3.1) (p = 0.008). Complications developed in 14 patients (20%). There was a tendency towards fewer admissions to intensive care, less acute kidney injuries and less acute respiratory distress syndrome (ARDS) in the laparoscopic group. Among patients who underwent laparoscopic surgery, the chance of uneventful recovery were 4.3 times higher than those patients who underwent open surgery (95% CI = 1.3 - 13.5, p = 0.014). Laparoscopy in the treatment of perforated duodenal ulcer is safe and can be utilized as a routine approach for the treatment of this pathology.