Laparoscopy versus laparotomy for upper gastrointestinal perforation in elderly patients

Objective: To compare the efficacy of laparoscopy versus laparotomy in the treatment of upper gastrointestinal (GI) ulcer perforations in elderly patients. Methods: A total of 100 patients with upper GI ulcer perforation treated in our hospital from January 2014 to December 2016 were enrolled in this study. All the eligible patients were older than 60 years and received emergency surgeries. They were randomly divided into two groups: the laparoscopy group (n=50) and the laparotomy group (n=50). The intraoperative factors, postoperative recovery, complication rate, postoperative pain, QOL (quality of life) scores and serum inflammatory cytokine (hs-CRP, TNF-α and IL-6) levels were compared between the two groups. Results: As compared with the laparotomy group, the laparoscopy group significantly reduced operation time, intraoperative bleeding, and length of hospital stay (P<0.05). Significantly shorter time for gastrointestinal function recovery, anal exhaustion and postoperative ambulation was also observed in the laparoscopy group (P<0.05). In addition, the laparoscopy group had significantly lower incidence of overall complications (P<0.05). As for the magnitude of postoperative pain, the VAS scores at 1 day and 3 days after surgery were significantly lower (P<0.05) and the postoperative QOL at 1 month and 3 months significantly improved in the laparoscopy group (P<0.05). The postoperative inflammatory cytokineshs-CRP, TNF-α and IL-6 levels at 1 week were also significant lower in the laparoscopy group (P<0.05). Conclusion: For treatment of upper GI perforation in elderly patients, laparoscopy is significantly superior to laparotomy in reducing the presence of complications and inflammatory reactions, alleviating postoperative pain and improving therapeutic effects. Therefore, it is beneficial to elderly patients.