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Pan CW, Liou LR, Mong FY, Tsao MJ, Liao GS. Simple laparoscopic repair of perforated peptic ulcer without omental patch. Asian J Surg 2019; 43:311-314. [PMID: 31677897 DOI: 10.1016/j.asjsur.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/02/2019] [Accepted: 08/18/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE We evaluated the outcomes of laparoscopic repair of perforated peptic ulcers using simple closure only. METHODS This retrospective study included 79 patients who underwent laparoscopic repair of perforated peptic ulcers from January 2011 to February 2016. They were divided into two groups: repair with an omental patch and repair with simple closure only. All of them underwent peritoneal cavity lavage with several litres of warm normal saline. A closed suction drain system was placed for drainage of intra-abdominal abscess. Patients' age, sex, Boey score, perforation size, operation time, overall complications, and length of hospital stay were evaluated. RESULTS A total of 79 patients diagnosed with perforated peptic ulcers who underwent emergency laparoscopic operations were enrolled in this study. Thirty patients underwent simple closure without an omental patch (group A), and 49 patients underwent simple closure with an omental patch (group B). Between the two groups, there were no statistically significant differences in the patients' age, size of perforation, and Boey score. However, the operation time was significantly different (p < 0.05) between the groups, with the average time being 84.4 min in group A and 106.65 min in group B. There was no statistically significant difference in the complication rate or the average length of hospital stay. No patient underwent reoperation for complications. CONCLUSION Laparoscopic repair of a perforated peptic ulcer without an omental patch is a safe option and does not increase the morbidity and mortality rate.
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Affiliation(s)
- Chao-Wen Pan
- Department of General Surgery, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Penghu, Taiwan, ROC; Department of Surgery, Zuoying Branch of Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan, ROC.
| | - Li-Ren Liou
- Department of Surgery, Zuoying Branch of Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan, ROC.
| | - Fan-Yun Mong
- Department of Surgery, St. Joseph Hospital, Kaohsiung, Taiwan, ROC.
| | - Min-Jen Tsao
- Department of Surgery, Zuoying Branch of Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan, ROC.
| | - Guo-Shiou Liao
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Moggia E, Athanasopoulos PG, Hadjittofi C, Berti S. Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:197. [PMID: 27294093 DOI: 10.21037/atm.2016.04.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pyloroplasty is currently reserved for emergencies (perforation, bleeding), but may occasionally be performed to treat benign gastric outlet obstruction (GOO). Historically, two techniques are available: the Mikulicz pyloroplasty, by which the pylorus is incised longitudinally and sutured vertically, and the Finney pyloroplasty, by which a U-shaped inverted incision is made in the second part of duodenum (D1-D2), followed by a side-to-side gastroduodenostomy. We report our experience in this single case of laparoscopic Finney pyloroplasty (LFP) performed in the emergency setting for a woman with a perforated duodenal ulcer and severe loss of tissue in D1-D2. Due to the presence of severely inflamed perforation edges and the risk of duodenal narrowing with subsequent GOO, Finney technique was favored over direct ulcer repair. The patient achieved a full postoperative recovery free of complications, with a dynamic oral contrast study demonstrating good gastric evacuation. Review of the current literature revealed no similar cases, as LFP has only been performed in the canine model. Although LFP requires a specific surgical skill-set, we believe it can be effective and feasible in cases of duodenal perforation with significant loss of mural substance.
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Affiliation(s)
- Elisabetta Moggia
- 1 Advanced Laparoscopic and Thoracoscopic General Surgery Department, Sant' Andrea Hospital, POLL ASL 5, La Spezia, Italy ; 2 HPB & Liver Transplant Surgery Department, Royal Free London Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK ; 3 Cardiothoracic Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Panagiotis G Athanasopoulos
- 1 Advanced Laparoscopic and Thoracoscopic General Surgery Department, Sant' Andrea Hospital, POLL ASL 5, La Spezia, Italy ; 2 HPB & Liver Transplant Surgery Department, Royal Free London Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK ; 3 Cardiothoracic Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Christopher Hadjittofi
- 1 Advanced Laparoscopic and Thoracoscopic General Surgery Department, Sant' Andrea Hospital, POLL ASL 5, La Spezia, Italy ; 2 HPB & Liver Transplant Surgery Department, Royal Free London Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK ; 3 Cardiothoracic Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Stefano Berti
- 1 Advanced Laparoscopic and Thoracoscopic General Surgery Department, Sant' Andrea Hospital, POLL ASL 5, La Spezia, Italy ; 2 HPB & Liver Transplant Surgery Department, Royal Free London Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK ; 3 Cardiothoracic Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
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Abd Ellatif ME, Salama AF, Elezaby AF, El-Kaffas HF, Hassan A, Magdy A, Abdallah E, El-Morsy G. Laparoscopic repair of perforated peptic ulcer: patch versus simple closure. Int J Surg 2013; 11:948-51. [PMID: 23806652 DOI: 10.1016/j.ijsu.2013.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic correction of perforated peptic ulcer (PPU) has become an accepted way of management. Patch omentoplasty stayed for decades the main method of repair. The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as patch omentoplasty. METHODS Since June 2005, 179 consecutive patients of PPU were treated by laparoscopic repair at our centers. We conducted a retrospective chart review in December 2012. Group I (patch group) included patients who were treated with standard patch omentoplasty. Group II (non-patch group) included patients who received simple repair without patch. RESULTS From June 2007 to Dec. 2012, 179 consecutive patients of PPU who were treated by laparoscopic repair at our centers were enrolled in this multi-center retrospective study. 108 patients belong to patch group. While 71 patients were treated with laparoscopic simple repair. Operative time was significantly shorter in group II (non patch) (p = 0.01). No patient was converted to laparotomy. There was no difference in age, gender, ASA score, surgical risk (Boey's) score, and incidence of co-morbidities. Both groups were comparable in terms of hospital stay, time to resume oral intake, postoperative complications and surgical outcomes. CONCLUSION Laparoscopic simple repair of PPU is a safe procedure compared with the traditional patch omentoplasty in presence of certain selection criteria.
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Affiliation(s)
- M E Abd Ellatif
- General Surgical Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Lo HC, Wu SC, Huang HC, Yeh CC, Huang JC, Hsieh CH. Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer. World J Surg 2011; 35:1873-8. [PMID: 21533964 DOI: 10.1007/s00268-011-1106-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. METHODS From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. RESULTS Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. CONCLUSIONS In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch.
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Affiliation(s)
- Hung-Chieh Lo
- Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, No. 2 Yuh-Der Road, Taichung, 404, Taiwan
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Lee J, Sung K, Lee D, Lee W, Kim W. Single-port laparoscopic repair of a perforated duodenal ulcer: intracorporeal "cross and twine" knotting. Surg Endosc 2010; 25:229-33. [PMID: 20549241 DOI: 10.1007/s00464-010-1164-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 05/23/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Single-port laparoscopic surgery is increasingly used to treat various types of diseases requiring surgical intervention. We present the technique and the results of our simple "cross and twine" intracorporeal knotting approach for treatment of a perforated duodenal ulcer. METHODS From January 2009 to October 2009, 13 patients with perforated duodenal ulcers underwent single-port laparoscopic repair. The laparoscopic procedure included peritoneal lavage and suture of the perforation. The omentum above the repair site was then reinforced. After surgery, patients took an H2 receptor antagonist for 8 weeks and then underwent follow-up gastrofiberscopy. RESULTS All procedures were completed under the conditions described. The mean operative time was 90.2 ± 24.2 min, and the mean hospital stay was 6.1 ± 0.5 days. The mean number of times that opiates were used for pain was 0.5 ± 1.0, and wound length was 1.9 ± 0.1 cm. There was no operation-related morbidity. Follow-up gastrofiberscopy revealed good lesion healing. CONCLUSIONS Single-port laparoscopic repair using the "cross and twine" knotting technique is a feasible and safe procedure, and it may be a less invasive laparoscopic surgical technique for scarless surgical treatment of perforated duodenal ulcers.
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Affiliation(s)
- Junhyun Lee
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Gyeongji-do, Korea
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Song KY, Kim TH, Kim SN, Park CH. Laparoscopic repair of perforated duodenal ulcers: the simple "one-stitch" suture with omental patch technique. Surg Endosc 2007; 22:1632-5. [PMID: 18030520 DOI: 10.1007/s00464-007-9670-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/28/2007] [Accepted: 08/29/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND We present, here, the technique and results of our laparoscopic simple "one-stitch" suture with omental patch technique for treating 35 patients with perforated duodenal ulcer. METHODS The laparoscopic treatment included peritoneal lavage, suture of the perforation without knotting, and then tying the suture over the omentum. Follow-up gastroscopy was performed after an eight-week course of medication with proton-pump inhibitors. RESULTS Conversion to laparotomy was necessary for two patients, because of a large-sized perforation and the inadequate localization of the perforation site, respectively. The mean operative time was 64 minutes and the mean hospital stay was 6.8 days. Operation-related complications occurred in two patients, including one case of pneumonia and one case of gastric stasis. CONCLUSIONS This simple "one-stitch" suture with omental patch technique is a safe and easy procedure, and it has an acceptable morbidity rate and a low conversion rate.
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Affiliation(s)
- Kyo-Young Song
- Department of Surgery, The Catholic University of Korea, College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul, Korea
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Wong BPY, Chao NSY, Leung MWY, Chung KW, Kwok WK, Liu KKW. Complications of peptic ulcer disease in children and adolescents: minimally invasive treatments offer feasible surgical options. J Pediatr Surg 2006; 41:2073-5. [PMID: 17161209 DOI: 10.1016/j.jpedsurg.2006.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Surgery for complications of peptic ulcer disease (PUD) carries a significant morbidity and even mortality. The aim of this study was to determine the efficacy, safety, and outcome of children and adolescents undergoing minimally invasive treatment of bleeding and perforation complicating PUD. METHODS One hundred thirty-two consecutive patients aged 6 to 17 years managed endoscopically for bleeding and laparoscopically for perforation from January 1999 to February 2006 were reviewed. RESULTS Thirty children had significant endoscopic stigma of recent hemorrhage. Primary endoscopic hemostasis was achieved in most cases except one requiring further endoscopic hemostasis. Seventeen patients with perforation underwent laparoscopic patch repair. Four patients were converted to open repair because of technical difficulty and the large size of the ulcer. All patients had a course of proton pump inhibitors postoperatively. Ninety percent of patients had Helicobacter pylori infestation. Triple therapy was given. Two patients defaulted triple therapy and presented later with recurrent ulcer bleeding. All others remained asymptomatic on follow-up (average, 32.6 months). CONCLUSIONS Endoscopic hemostasis of bleeding peptic ulcer is effective and safe in children. With stringent criteria, laparoscopic patch repair of perforation can be applied safely to most pediatric patients. Eradication of H pylori and subsequent antiulcer medication are integral in the management of complicated PUD.
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Affiliation(s)
- Beatrice P Y Wong
- Division of Paediatric Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Lipof T, Shapiro D, Kozol RA. Surgical perspectives in peptic ulcer disease and gastritis. World J Gastroenterol 2006; 12:3248-52. [PMID: 16718847 PMCID: PMC4087970 DOI: 10.3748/wjg.v12.i20.3248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 04/06/2006] [Accepted: 04/16/2006] [Indexed: 02/06/2023] Open
Abstract
For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
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Affiliation(s)
- Tamar Lipof
- Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, MC 3955 Farmington, CT 06030-3955, USA
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Siu WT, Chau CH, Law BKB, Tang CN, Ha PY, Li MKW. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg 2004; 91:481-4. [PMID: 15048752 DOI: 10.1002/bjs.4452] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair for perforated peptic ulcer in routine clinical practice. METHODS This was a prospective analysis of 172 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 1997 and June 2003. RESULTS One hundred and seventy-two patients of mean age 54 (range 14-93) years had perforated peptic ulcer diagnosed by laparoscopy. There were 172 duodenal ulcers, 22 prepyloric and 13 non-juxtapyloric gastric ulcers. One hundred and sixty-five patients underwent omental patch closure of perforations; there were six Pólya gastrectomies and one ulcerectomy. Thirty-seven patients (21.5 per cent) required conversion to laparotomy. The mean operating time was 64.8 (range 14-180) min. The median postoperative requirement for intramuscular pethidine was one dose. The median postoperative hospital stay was 6 days. Complications occurred in 28 patients (16.3 per cent) resulting in three reoperations. Six patients with intra-abdominal collections were managed by percutaneous drainage. Two patients who underwent conversion developed a wound infection. Fourteen patients (8.1 per cent) died, 11 of whom were American Society of Anesthesiologists grade III and IV. CONCLUSION Laparoscopic repair of perforated peptic ulcer is a safe emergency procedure in routine clinical practice for patients with perforated pyloroduodenal ulcer.
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Affiliation(s)
- W T Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
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