Mustafa KARAAĞAÇ, Sedat ÇARKIT
Laparoscopic Endoscopic Surgical Science - 2025;32(4):197-207
Introduction: The necessity of routine intraoperative biopsy during emergency surgery for peptic ulcer perforation (PUP) remains controversial when malignancy is not suspected. This study evaluated the diagnostic yield of intraoperative biopsy and identified prognostic factors for mortality and intensive care unit (ICU) admission. Materials and Methods: This retrospective single-center cohort included 77 adults undergoing emergency laparotomy for PUP, excluding tumor perforations and cases with radiological suspicion of malignancy. Results: Intraoperative biopsy was performed in 58.4% of patients, detecting malignancy in only one case (1.3%). No malignancy was found on postoperative endoscopy in patients without intraoperative suspicion. Overall mortality was 11.7% and was significantly associated with advanced age, delayed presentation, larger perforation size, comorbidity, higher Boey and PULP scores, elevated creatinine, and hypoalbuminemia. Conclusions: Routine intraoperative biopsy provides minimal diagnostic benefit in the absence of macroscopic suspicion of malignancy. A selective approach, guided by intraoperative findings and supported by early postoperative endoscopy, appears safe and sufficient.
