Perforated peptic ulcer complications have remained stable and associated with a morbidity rate of 10-20%. A study demonstrated that surgical procedures such as laparoscopic surgery yield better perioperative outcomes with safe repair in elderly patients with perforated peptic ulcer (PPU) complications.

The present study was conducted to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in elderly patients using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study.

This study is a retrospective analysis of data of the FRAILESEL study. Data of elderly patients who underwent emergency abdominal surgery for PPU from Jan 2017 to Dec 2017 were analyzed. All the patients were further categorized into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastro duodenal repair (OGR) cohort. The clinicopathologic features of the patients enrolled in both groups were compared.

A total of 67 patients were enrolled in the study. Among 67 patients, 37 patients underwent LGR. The patients who underwent LGR experienced less blood loss and had a shorter postoperative stay, even if the difference was not statistically significant.

The mean operative time was significantly higher in the OGR group (96.5±27.7) as compared to the LGR group (78.6±16.3) as depicted in the following figure:

The death rate was similar after laparoscopic surgery and open surgery. Independent variables associated with the risk of overall mortality observed in multivariate analysis were age, lactate level, platelet count, admission hemoglobin (Hb) level, and Mannheim Peritonitis Index.

Laparoscopic gastro duodenal repair (LGR) appears to be a safe and feasible management option for perforated peptic ulcers in elderly patients. Better treatment outcomes can be achieved through patient selection and preoperative frailty evaluation in the elderly population.