Intraoperative complications Four patients on the laparoscopic group were required to convert to the open surgery group. Inability to visualize the ulcer defect because of bleeding (n=1/52) Inability to reach the defect because of the perforation in the vicinity of the gastroduodenal ligament and because of dorsal gastric ulcer (n=2/52) Inability to find the perforation (n=1/52)
Since eight out of 109 patients were discovered to have a diagnosis different than PPU, this study supported the benefit of using laparoscopy as a diagnostic procedure. Conversion rate in the laparoscopy group were much lower than the reported literature (8% vs 60%), although this can be attributed to the fact that only trained and experienced (more than 50 procedures year) participated in the study.
Operating time was significantly longer in the laparoscopy group (75min vs 50min) which may be due to the following: – Laparoscopic suturing is more demanding – Longer irrigation procedure
This study further support the evidence that laparoscopic correction of PPU causes less postoperative pain. This study also proves the cosmetic benefit of laparoscopic surgery because it decreases the awareness or concern of the patients with the appearance of scars, as supported by the VAS scores. However, no statistical difference were noted on the hospital stay of both groups.
Conclusion This LAMA trial confirm the results of other trials that laparoscopic correction of PPU is safe, feasible for the experienced laparoscopic surgeon, and causes less operative pain. Operating time was longer in the laparoscopic group. No difference in the length of hospital stay or incidence of postoperative complications.