Laparoscopic repair of peptic ulcer perforation without omental patch versus conventional open repair.

BACKGROUND: Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. Nevertheless, most studies have shown that the disadvantages of the laparoscopic treatment of peptic ulcers are a long operation time, a high reoperation rate, and a need for an experienced surgeon. Thus, the objective of the current study was to compare the safety and efficacy of optimized laparoscopic surgery without an omental patch for a perforated peptic ulcer within a shorter operational time with conventional open surgery in a 4-year period. PATIENTS AND METHODS: From May 2002 to June 2006, 35 consecutive patients with a clinical diagnosis of a perforated peptic ulcer were prepared prospectively to undergo either an open or optimized laparoscopic surgery. RESULTS: Seventeen patients with a perforated peptic ulcer underwent simple laparoscopic repair without an omental patch. Three patients (17.6%) who were begun by the laparoscopic approach had to be converted to open surgery. Eighteen patients underwent conventional open surgery. The mean operative time for laparoscopic repair was 42.10 minutes (range, 35-60), which was significantly shorter than the 55.83 minutes for open repair (range, 35-72; P = 0.001). Postoperative parenteral analgesic requirements were lower after laparoscopic repair (75.0 mg) than that after an open repair procedure (101.39 mg; P = 0.02). There was no statistically significant difference between the procedures in terms of hospital stay (5 vs. 5.33 days; P = 0.37) and the timing of access to normal daily activity (6.8 vs. 7.1 days) (P = 0.54). CONCLUSIONS: Laparoscopic surgery, when optimized by a simple repair without an omental patch and 10 mm of a large-channel aspirator-irrigator, may be safely and effectively applied to the patients with small duodenal perforated peptic ulcers (<10 mm) and because of its having low risk factors. The procedure may be an alternative treatment to other procedures when in experienced hands.

Effects of high bilirubin levels on the healing of intestinal anastomosis.

PURPOSE: This article analyzes the relationship between high biluribin levels and anastomotic healing in the long term. METHODS: Ninety rats were randomly divided into six groups. The first three groups were jaundiced while the other three were unjaundiced. In the jaundiced groups, the rats' common bile ducts were ligated for 1, 2, and 3 weeks and ileal anastomosis was performed. In unjaundiced groups, only anastomosis was performed for 1, 2, and 3 weeks. At the end of the study, the values of the bursting pressures and hydroxyproline levels were determined in all groups. The bilirubin levels were also followed in jaundiced groups. RESULTS: In the jaundiced groups, the mean hydroxyproline contents were 7.5 +/- 4.0, 6.3 +/- 2.3, and 5.6 +/- 2.1 (microHP/mg tissue) and the mean bursting pressures were 178 +/- 38, 171 +/- 23, and 164 +/- 26 mmHg at weeks 1, 2, and 3, respectively. In the unjaundiced groups, the mean hydroxyproline contents were 7.6 +/- 3.2, 8.1 +/- 3.0, and 8.6 +/- 2.5 (microHP/mg tissue) and the mean bursting pressures were 181 +/- 28, 183 +/- 21, and 186 +/- 22 mmHg at weeks 1, 2, and 3, respectively. The bilirubin levels were 3.8 +/- 1.5, 6.5 +/- 2.3, and 11.2 +/- 2.9 mg/dl at weeks 1, 2, and 3, respectively, in the jaundiced groups and 0.6 +/- 0.06, 0.6 +/- 0.03, and 0.7 +/- 0.04 mg/dl in the unjaundiced groups. CONCLUSION: This study showed that the bilirubin levels can lead to a deterioration depending on the magnitude of the rise in the bilirubin levels.