Laparoscopic repair of early versus delayed presented perforated peptic ulcer: a prospective comparative study

Background Perforated peptic ulcer is one of the common surgical emergencies. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990 and is gaining acceptance. The main concerns are postoperative intra-abdominal collections and performing laparoscopy in the presence of peritonitis. Studies that evaluate the role of laparoscopy in early and delayed presentation are deficient. Aim To compare laparoscopic repair in early versus delayed presentation of perforated peptic ulcer in terms of operative time, conversion rate, postoperative pain, postoperative complications, hospital stay, and conversion rate. Patients and methods This nonrandomized interventional study recruited 140 patients with perforated peptic ulcer who underwent laparoscopic repair and were admitted at the General Surgery Department (Emergency Unit) during the period between May 2019 and June 2021. This study was conducted at the main tertiary referral institution that covers the population in Upper Egypt. Only experienced laparoscopic surgeons participated in this study. Results A total of 140 patients were included in this study; 75 patients underwent laparoscopic repair during the early presentation period (within 24 h), and their mean age was 42 +/- 12.4 years, whereas 65 patients underwent laparoscopic repair during the late presentation period (>24 h), and their mean age was 45 +/- 9.8 years. Operative time was significantly longer in the late laparoscopic group (120 +/- 14.6 min) in comparison with the early group (80 +/- 10.6 min). Moreover, the conversion rate was significantly higher in the late group. The postoperative complications were higher in the late group than the early group. Conclusions Laparoscopic repair of perforated peptic ulcer is safe and reliable even in delayed presentations with peritonitis. It has an acceptable morbidity and all the advantages of a minimally invasive surgical approach.