Peptik Ülser Perforasyonu: Laparoskopik ve Açık Onarımın Klinik sonuçları

Öz

Amaç: Bu çalışma, peptik ülser perforasyonu (PUP) olgularında laparoskopik ve açık cerrahi onarım yöntemlerinin perioperatif ve postoperatif sonuçlarını karşılaştırarak minimal invaziv cerrahinin etkinliğini ve güvenilirliğini değerlendirmeyi amaçlamaktadır. Yöntemler: Temmuz 2020–2025 tarihlerinde PUP nedeniyle opere edilen 80 hasta retrospektif olarak değerlendirildi. Laparoskopik cerrahi uygulanan Grup A (n = 35) ile açık cerrahi uygulanan Grup B (n = 45), klinik ve cerrahi sonuçlar açısından karşılaştırıldı. Analizlerde p<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Grupların demografik ve preoperatif özellikleri benzerdi. Laparoskopik grupta ameliyat süresi (80,5 ± 15,2 dk), dren çekilme (3,3 ± 0,9 gün), oral alıma geçiş (1,9 ± 0,8 gün) ve hastanede kalış süreleri (5,4 ± 1,2 gün) açık cerrahi grubuna göre sırasıyla 106,9 ± 21,3 dk, 5,1 ± 1,1 gün, 5,1 ± 1,4 gün ve 10,0 ± 2,5 gün olup anlamlı derecede daha kısaydı (p < 0,001). Postoperatif 1. gün ağrı skoru laparoskopik grupta 4,1 ± 0,8, açık grupta 6,0 ± 1,1 bulundu (p < 0,001). Komplikasyon oranları cerrahi alan enfeksiyonu (CAE) (p = 0,024), atelektazi (p = 0,002) ve insizyonel herni (p = 0,032)] açık cerrahi grubunda anlamlı olarak daha yüksek bulundu Sonuç: Laparoskopik onarım, PUP tedavisinde açık cerrahiye kıyasla daha kısa ameliyat süresi, azalmış komplikasyon oranı ve belirgin ağrı kontrolüyle iyileşmeyi hızlandırmaktadır. Laparoskopik yaklaşım, güvenli ve etkili bir yöntem olup, hasta konforunu ve postoperatif iyileşmeyi sürecine olumlu katkı sağlayabilir.

Anahtar Kelimeler

• Peptik ülser perforasyonu
• laparoskopik cerrahi
• açık onarım
• postoperatif komplikasyon

Peptic Ulcer Perforation: Clinical Outcomes of Laparoscopic and Open Repair

Öz

Objective: This study aimed to assess the efficacy and safety of minimally invasive surgery by comparing perioperative and postoperative outcomes between laparoscopic and open repair in patients with peptic ulcer perforation (PUP). Methods: Eighty patients who underwent surgery for PUP between July 2020 and 2025 were retrospectively analyzed. Patients were divided into two groups: Group A (n = 35) underwent laparoscopic repair, and Group B (n = 45) underwent open repair. Clinical and surgical outcomes were compared. A p value of <0,05 was considered statistically significant. Results: Baseline demographic and preoperative characteristics were comparable between the groups. In the laparoscopic group, the operation time (80,5 ± 15,2 min), drain removal (3,3 ± 0,9 days), time to oral intake (1,9 ± 0,8 days), and hospital stay (5,4 ± 1,2 days) were significantly shorter than those in the open group (106,9 ± 21,3 min, 5,1 ± 1,1 days, 5,1 ± 1,4 days, and 10,0 ± 2,5 days, respectively; p < 0,001). The pain score on the first postoperative day was significantly lower in the laparoscopic group (4,1 ± 0,8) compared with the open group (6,0 ± 1,1; p < 0,001). Complication rates—including surgical site infection (p = 0,024), atelectasis (p = 0,002), and incisional hernia (p = 0,032)—were markedly higher in the open surgery group. Conclusion: Laparoscopic repair significantly enhances recovery in PUP management through shorter operative times, reduced complication rates, and superior postoperative pain control compared with open surgery. It represents a safe and effective approach that improves patient comfort and accelerates postoperative recovery.

Anahtar Kelimeler

• Peptic ulcer perforation
• laparoscopic surgery
• open repair
• postoperative complications.

Kaynakça

1. 1.Salman MA, Issa M, Salman A, et al. SurgicalManagement of Perforated Peptic Ulcer: AComparative Meta-analysis of Laparoscopic VersusOpen Surgery. Surg Laparosc Endosc Percutan Tech.2022; 32(5): 586-94.
2. 2.Eghbali F, Banijamali M, Jahanshahi F, et al.Comparison of Mortality and Postoperative Complications Between Open and LaparoscopicRepair of Perforated Peptic Ulcer: An UmbrellaReview. Minim Invasive Surg. 2024; 1: 5521798.
3. 3.Aiad GAFN, Dowara SF, Salman MA, Radwan OA,Massoud RAK. Role of Laparoscopic versus OpenApproach in Acute Peptic Ulcer Perforation inEgyptian Population; A Randomized ControlledTrial. IJCBS. 2023; 24(9): 252-7.
4. 4.Gölgeli H, Ecirli Ş, Kutlu O, Başer H, Karasoy D. Üstgastrointestinal sistem kanaması nedeniyle izlenenhastaların değerlendirilmesi. Dicle Med J. 2014;41(3): 495-501.
5. 5. Bhogal RH, Athwal R, Durkin D, Deakin M, CheruvuCN. Comparison between open and laparoscopicrepair of perforated peptic ulcer disease. World JSurg. 2008; 32(11): 2371-4.
6. 6.Jiang JH, Lee SY, Tung HF, Tsai YW. Comparison oftrans-umbilical single-port laparoscopic surgeryand laparotomy for repair of perforated peptic ulcerin pediatric patients: a retrospective study. BMCSurg. 2025; 25: 283.
7. 7.Chavarkar A, Dabholkar S, Dake C, Ombase S.Minimally Invasive Superiority: LaparoscopicSurgery Reduces Complications and EnhancesRecovery in Perforated Peptic Ulcer Peritonitis. Int JLife Sci. 2025; 11(3): 7632-8.
8. 8.Ibrahim AH. Comparative study betweenlaparoscopic and open omentoplasty repair ofperforated duodenal peptic ulcer. MJMR. 2024; 35(3): 1-13.

9. 9.Chalmers KA, Le M, Cousins SE, et al. Laparoscopicversus open repair of perforated peptic ulcer: asystematic scoping review and in-depth evaluationof existing evidence. BJS Open. 2025; 9(2): zrae163.
10. 10.Tartaglia D, Strambi S, Coccolini F, et al.Laparoscopic versus open repair of perforatedpeptic ulcers: analysis of outcomes andidentification of predictive factors of conversion.Updates Surg. 2023; 75(3): 649-57.
11. 11.Stamate E, Piraianu AI, Duca OM, et al. The Effectof Increased Intra-Abdominal Pressure onHemodynamics in Laparoscopic Cholecystectomy—The Experience of a Single Centre. J Pers Med. 2024;14(8): 871.
12. 12.Ali I, Akbar F, Khan AA, et al. Outcome of openrepair versus laparoscopic surgery in patients withduodenal ulser perforation. JMHSR. 2025; 2(2):5339-45.
13. 13.Patil JrM, Gharde P, Reddy K, Nayak K.Comparative analysis of laparoscopic versus openprocedures in specific general surgicalinterventions. Cureus. 2024; 16(2): e54433.
14. 14.Aslan F, Karayıl AR. The Effect of Laparoscopicand Laparotomic Surgery On Post Op Mortality andMorbidity in Repair of Peptic Ulcer Perforation. EastJ Med. 2024; 29(1): 14-7.
15. 15.Costa G, Garbarino GM, Lepre L, et al.Laparoscopic treatment of perforated peptic ulcer: apropensity score-matched comparison ofinterrupted stitches repair versus knotless barbedsuture. J Clin Med. 2024; 13(5): 1242.
16. 16.Lunevicius R, Morkevicius M. Comparison oflaparoscopic versus open repair for perforatedduodenal ulcers. Surg Endosc. 2005; 19(12): 1565-71.
17. 17.Wadewitz E, Friedrichs J, Grilli M, et al.Approaches for the treatment of perforated pepticulcers: a network meta-analysis of randomizedcontrolled trials. Langenbecks Arch Surg. 2025;410(1): 266.