십이지장궤양 천공의 단순 봉합치료 : 복강경과 개복술식의 비교 연구

초록

Purpose: Perforated duodenal ulcer can be treated by various methods ranging from non-operative management to immediate definitive acid-reduction surgery. With the current availability of potent H2 blockers, proton pump inhibitors, and effective Helicobacter pylori (H. pylori) eradication regimens, ulcer recurrence is usually low and the need for definitive surgery has decreased. Furthermore, the introduction of laparoscopic closure has weakened the principles of the conventional surgical approach, and surgeons are now faced with the choice between definitive surgery and omental patch repair, and between open or laparoscopic surgery. The aims of this study were to evaluate the feasibility and efficacy of laparoscopic omental patch repair in comparison with conventional surgery, and to investigate the status of H. pylori infection and the role of H. pylori eradication. In addition, we introduce our unique surgical experience using a 3-port technique. Methods: We treated 31 patients with perforated duodenal ulcer laparoscopically and compared them with 30 patients who underwent conventional omental patch repair. The patients treated by laparoscopy were evaluated for postoperative H. pylori status. H. pylori–positive patients received a 1- or 2-week course of omeprazole plus amoxicillin and clarithromycin. Results: Laparoscopic repair was successful in 26 cases, and the conversion rate was 16.1%. There was no statistically significant difference in operative time or mortality. Morbidity was comparable between the two groups, although wound infection was more common in the open group. The clinical course and hospital stay were significantly shorter in the laparoscopic group. The H. pylori infection rate was 47%, and there were 2 cases of ulcer recurrence and 2 cases of reperforation in H. pylori–negative patients. Conclusions: Laparoscopic closure of perforated duodenal ulcer using a 3-port technique is a technically feasible and safe alternative to open repair, offering early recovery and low morbidity. H. pylori is positive in about half of patients with perforated duodenal ulcer and should be eradicated in those who test positive. Other risk factors for ulcer perforation should also be identified.

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