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Li ZW, Tong Y, Liu F, Liu XR, Lv Q, Tang KL, Li LS, Liu XY, Zhang W, Peng D. A comparative study on laparoscopic and open surgical approaches for perforated peptic ulcer repair: efficacy and outcomes analysis. Langenbecks Arch Surg 2023; 408:435. [PMID: 37964034 DOI: 10.1007/s00423-023-03171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE This study aimed to compare the clinical outcomes of the clinical outcomes of laparoscopic and open sutures for peptic ulcer perforation (PPU). MATERIALS AND METHODS PubMed, EMBASE, and Cochrane Library databases were searched for eligible studies from inception to March 31, 2023. Odds ratios (OR) and 95% confidence intervals (Cl) were also calculated. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. This study was performed using the Stata (V.16.0) software. RESULTS A total of 29 studies involving 17,228 patients were included in this study. In terms of postoperative outcomes, the laparoscopic group had a shorter postoperative hospital stay (MD = -0.29, 95%CI = -0.44 to -0.13, P = 0.00), less blood loss (MD = -0.45, 95%CI = -0.82 to -0.08, P = 0.02), fewer wound infection (OR = 0.20, 95%CI = 0.17 to 0.24, P = 0.00), fewer pneumonia (OR = 0.59, 95%CI = 0.41 to 0.87, P = 0.01), fewer respiratory complications (OR = 0.26, 95%CI = 0.13 to 0.55, P = 0.00) and lower postoperative morbidity (OR = 0.51, 95%CI = 0.33 to 0.78, P = 0.00). The laparoscopic group had a lower mortality rate (OR = 0.36, 95%CI = 0.27 to 0.49, P = 0.00) than the open group. We also found that the laparoscopic group had a higher overall complication rate than the open group (OR = 0.45, 95%CI = 0.34 to 0.60, P = 0.00). CONCLUSION Laparoscopic repair was associated with a lower risk of mortality than open repair in patients with PPU. Laparoscopic repair may be a better option in patients with PPU.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kai-Lin Tang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lian-Shuo Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Tartaglia D, Strambi S, Coccolini F, Mazzoni A, Miccoli M, Cremonini C, Cicuttin E, Chiarugi M. Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion. Updates Surg 2022; 75:649-657. [PMID: 36192594 PMCID: PMC10042947 DOI: 10.1007/s13304-022-01391-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/25/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND The surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery. METHODS This retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion. RESULTS Of the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012-0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010-0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001-0.400; p = 0.012) were predictive factors for conversion to an open approach. CONCLUSION This study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair.
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Affiliation(s)
- Dario Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy.
| | - Silvia Strambi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Alessio Mazzoni
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Cremonini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Enrico Cicuttin
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa, 2, 56021, Pisa, Italy
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Wang YH, Wu YT, Fu CY, Liao CH, Cheng CT, Hsieh CH. Potential use of peptic ulcer perforation (PULP) score as a conversion index of laparoscopic-perforated peptic ulcer (PPU) repair. Eur J Trauma Emerg Surg 2020; 48:61-69. [PMID: 33219825 PMCID: PMC8825607 DOI: 10.1007/s00068-020-01552-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic repair is a well-accepted treatment modality for perforated peptic ulcer (PPU). However, intraoperative conversion to laparotomy is still not uncommon. We aimed to identify preoperative factors strongly associated with conversion. METHODS A retrospective review of records of all PPU patients treated between January 2011 and July 2019 was performed. Patients were divided into three groups: laparoscopic repair (LR), conversion to laparotomy (CL), and primary laparotomy (PL). Patient demographics, operative findings, and outcomes were compared between the groups. Logistic regression analyses were performed, taking conversion as the outcome. RESULTS Of 822 patients, there were 236, 45, and 541 in the LR, CL, and PL groups, respectively. The conversion rate was 16%. Compared with those in the LR group, patients in the CL group were older (p < 0.001), had higher PULP scores (p < 0.001), had higher ASA scores (p < 0.001) and had hypertension (p = 0.003). PULP score was the only independent risk factor for conversion. The area under the curve (AUC) for the PULP score to predict conversion was 75.3%, with a best cut-off value of ≥ 4. The operative time was shorter for PL group patients than for CL group patients with PULP scores ≥ 4. For patients with PULP scores < 4, LR group patients had a shorter length of stay than PL group patients. CONCLUSION The PULP score may have utility in predicting and minimizing conversion for laparoscopic PPU repair. Laparoscopic repair is the procedure of choice for PPU patients with PULP scores < 4, while open surgery is recommended for those with PULP scores ≥ 4.
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Affiliation(s)
- Yu-Hao Wang
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan 333, Linkou, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan 333, Linkou, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan 333, Linkou, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan 333, Linkou, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan 333, Linkou, Taiwan.
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4
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Tarasconi A, Coccolini F, Biffl WL, Tomasoni M, Ansaloni L, Picetti E, Molfino S, Shelat V, Cimbanassi S, Weber DG, Abu-Zidan FM, Campanile FC, Di Saverio S, Baiocchi GL, Casella C, Kelly MD, Kirkpatrick AW, Leppaniemi A, Moore EE, Peitzman A, Fraga GP, Ceresoli M, Maier RV, Wani I, Pattonieri V, Perrone G, Velmahos G, Sugrue M, Sartelli M, Kluger Y, Catena F. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 2020; 15:3. [PMID: 31921329 PMCID: PMC6947898 DOI: 10.1186/s13017-019-0283-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Matteo Tomasoni
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Dieter G. Weber
- Royal Perth Hospital, Perth, Australia & The University of Western Australia, Crawley, Australia
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fabio C. Campanile
- Division of Surgery, ASL VT - Ospedale “Andosilla”, Civita Castellana, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Michael D. Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew W. Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | | | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO USA
| | - Andrew Peitzman
- University of Pittsburgh, School of Medicine, UPMC – Presbyterian, Pittsburgh, PA USA
| | - Gustavo Pereira Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Marco Ceresoli
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ronald V. Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Imtaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - George Velmahos
- Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - Michael Sugrue
- Letterkenny University Hospital, Donegal Clinical Research Academy Centre for Personalized Medicine, Donegal, Ireland
| | | | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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5
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Sakamoto Y, Iwatsuki M, Sakata K, Toyama E, Takata N, Yoshinaka I, Harada K, Baba H. Laparoscopic omental filling with intraoperative endoscopy for a perforated duodenal ulcer. Surg Today 2018; 48:1031-1034. [PMID: 29869066 DOI: 10.1007/s00595-018-1681-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/27/2018] [Indexed: 11/29/2022]
Abstract
As a surgical treatment for a perforated duodenal ulcer, duodenal omental filling is effective. However, filling the perforation site with a sufficient amount of omentum is difficult in some situations. We herein report that we successfully filled a perforated duodenal ulcer with a sufficient amount of omentum using intraoperative endoscopy. The operation was performed with three ports, the operation time was 110 min, and the estimated blood loss was small. The postoperative course was good. No stenosis of deformity of the duodenum was observed on follow-up endoscopy. Laparoscopic surgery has a shorter operation time, shorter postoperative hospital stay, and less postoperative pain than open surgery. The combined use of intraoperative endoscopy with laparoscopic surgery is effective for a large perforation, and it can be expected to reduce the rate of conversion to open surgery. This combined procedure is considered useful as a laparoscopic omental filling operation.
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Affiliation(s)
- Yuki Sakamoto
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kazuya Sakata
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan
| | - Eiichiro Toyama
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan
| | - Noboru Takata
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan
| | | | - Kazunori Harada
- Department of Surgery, Amakusa Medical Center, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
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Alekberzade AV, Krylov NN, Rustamov EA, Badalov DA, Popovtsev MA. [Perforated peptic ulcer closure: laparoscopic or open?]. Khirurgiia (Mosk) 2017:45-50. [PMID: 28303872 DOI: 10.17116/hirurgia2017245-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To compare laparoscopic and open closure of perforated peptic ulcer (PPU). MATERIAL AND METHODS The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. RESULTS Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. CONCLUSION Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - N N Krylov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - E A Rustamov
- Topchubashov Research Center of Surgery, Ministry of Health of the Azerbaijan Republic, Baku
| | - D A Badalov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - M A Popovtsev
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
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Kim JH, Chin HM, Bae YJ, Jun KH. Risk factors associated with conversion of laparoscopic simple closure in perforated duodenal ulcer. Int J Surg 2015; 15:40-4. [PMID: 25644542 DOI: 10.1016/j.ijsu.2015.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Precise patient selection criteria are necessary to guide the surgeon in selecting laparoscopic repair for patients with perforated peptic ulcers. The aims of this study are to report surgical outcomes after surgery for perforated duodenal ulcers and identify risk factors for predicting failure of laparoscopic simple closure for perforated duodenal ulcer. METHODS In total, 77 patients who underwent laparoscopic simple closure for perforated duodenal ulcers from January 2007 to September 2013 were retrospectively analyzed. Patients were divided into totally laparoscopic and conversion groups. The characteristics of patients, intraoperative findings, postoperative complications, conversion rates and suture leakage rates of each group were investigated. RESULTS Laparoscopic repair was completed in 69 (89.6%) of 77 patients, while 8 (10.4%) underwent conversion to open repair. Patients in the conversion group had longer perforation time, larger perforation size, more suture leakage, longer hospital stay, and higher 30-day mortality rate than those in the totally laparoscopic group. The size of perforation was the only risk factor for conversion in multivariable analysis. Patients with an ulcer perforation size of ≥9 mm or with perforation duration of ≥12.5 h had a significantly increased risk for conversion and suture leakage. CONCLUSIONS Ulcer size of ≥9 mm is a significant risk factor for predicting conversion in laparoscopic simple closure. Suture leakage is associated with ulcer size (9 mm) and duration of perforation (12.5 h).
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Affiliation(s)
- Ji-Hyun Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Hyung-Min Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - You-Jin Bae
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
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8
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Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models - are existing models sufficient? A retrospective cohort study. Int J Surg 2015; 14:38-44. [PMID: 25560748 DOI: 10.1016/j.ijsu.2014.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/10/2014] [Accepted: 12/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Emergency surgery for perforated peptic ulcer (PPU) is associated with significant morbidity and mortality. Accurate and early risk stratification is important. The primary aim of this study is to validate the various existing MRPMs and secondary aim is to audit our experience of managing PPU. METHODS 332 patients who underwent emergency surgery for PPU at a single intuition from January 2008 to December 2012 were studied. Clinical and operative details were collected. Four MRPMs: American Society of Anesthesiology (ASA) score, Boey's score, Mannheim peritonitis index (MPI) and Peptic ulcer perforation (PULP) score were validated. RESULTS Median age was 54.7 years (range 17-109 years) with male predominance (82.5%). 61.7% presented within 24 h of onset of abdominal pain. Median length of stay was 7 days (range 2-137 days). Intra-abdominal collection, leakage, re-operation and 30-day mortality rates were 8.1%, 2.1%, 1.2% and 7.2% respectively. All the four MRPMs predicted intra-abdominal collection and mortality; however, only MPI predicted leak (p = 0.01) and re-operation (p = 0.02) rates. The area under curve for predicting mortality was 75%, 72%, 77.2% and 75% for ASA score, Boey's score, MPI and PULP score respectively. DISCUSSION AND CONCLUSION Emergency surgery for PPU has low morbidity and mortality in our experience. MPI is the only scoring system which predicts all - intra-abdominal collection, leak, reoperation and mortality. All four MRPMs had a similar and fair accuracy to predict mortality, however due to geographic and demographic diversity and inherent weaknesses of exiting MRPMs, quest for development of an ideal model should continue.
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Affiliation(s)
- K Anbalakan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - G J Pandya
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - V G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore.
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9
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Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Meta-analysis of laparoscopic versus open repair of perforated peptic ulcer. JSLS 2013; 17:15-22. [PMID: 23743368 PMCID: PMC3662736 DOI: 10.4293/108680812x13517013317752] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A meta-analysis of four randomized trials comparing laparoscopic versus open repair of perforated ulcer did not demonstrate significant superiority of the laparoscopic or open approach. Background and Objectives: Laparoscopic treatment of perforated peptic ulcer (PPU) has been introduced as an alternative procedure to open surgery. It has been postulated that the minimally invasive approach involves less operative stress and results in decreased morbidity and mortality. Methods: We conducted a meta-analysis of randomized trials to test this hypothesis. Medline, EMBASE, and the Cochrane Central Register of Randomized Trials databases were searched, with no date or language restrictions. Results: Our literature search identified 4 randomized trials, with a cumulative number of 289 patients, that compared the laparoscopic approach with open sutured repair of perforated ulcer. Analysis of outcomes did not favor either approach in terms of morbidity, mortality, and reoperation rate, although odds ratios seemed to consistently support the laparoscopic approach. Results did not determine the comparative efficiency and safety of laparoscopic or open approach for PPU. Conclusion: In view of an increased interest in the laparoscopic approach, further randomized trials are considered essential to determine the relative effectiveness of laparoscopic and open repair of PPU.
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Affiliation(s)
- Stavros A Antoniou
- Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany.
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10
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Wadaani HA. Emergent laparoscopy in treatment of perforated peptic ulcer: a local experience from a tertiary centre in Saudi Arabia. World J Emerg Surg 2013; 8:10. [PMID: 23497473 PMCID: PMC3614460 DOI: 10.1186/1749-7922-8-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/29/2013] [Indexed: 11/22/2022] Open
Abstract
Background/ purpose Perforated peptic ulcer (PPU) is still an existing disease that occurs frequently in the 21st century despite of the wide availability of antiulcer medication and Helicobacter eradication. The current study aimed to evaluate the hypothesis that its outcome might be improved by using the laparoscopy. The outcome of treatment in terms of complications, mortality and hospital stay with relevant to laparoscopy was analyzed. Patients and methods This prospective descriptive study was carried on the period of 3 years from July 2009 till July 2012. All patients with acute abdominal pain that was clinically diagnosed as having perforated peptic ulcer were included. Excluded from this study were those patients with concomitant bleeding from the ulcer and evidence of gastric outlet obstructions. Also excluded were those with evidence of large perforation more than 10 mm and patients with symptoms of more than 36 h durations for fear of septic shock. Results Forty seven patients were studied out of a total 53 PPU patients; they were 41 males and 6 females with the male to female ratio of 6.8:1. Their age ranged from 19 to 55 years with the mean age of 39.5 ± 8.6 years. Forty five patients were successfully treated by laparoscopy while only 2 cases that were early presented with signs of hypovolumic shock were converted into laparotomy due to severe bleeding. The mean hospital stay was 75 ± 12.6 h. Post operative complications included death of one patient in the postoperative period at the Intensive care unit (ICU) plus post operative fever in the 2 patients who underwent laparotomy and it was amenable to treatment. Conclusions Laparoscopic repair of a perforated peptic ulcer is an amenable and feasible technique within the hands of experienced laparoscopic surgeon when the cases are early and properly diagnosed.
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Affiliation(s)
- Hamed Al Wadaani
- Department of Surgery, College of Medicine, King Faisal University & King Fahd Hospital, Al- Ahsa, KSA.
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11
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Critchley AC, Phillips AW, Bawa SM, Gallagher PV. Management of perforated peptic ulcer in a district general hospital. Ann R Coll Surg Engl 2011; 93:615-9. [PMID: 22041238 DOI: 10.1308/003588411x13165261994030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. METHODS Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. RESULTS The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p <0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs. CONCLUSIONS Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.
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Affiliation(s)
- A C Critchley
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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12
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Bonin EA, Moran E, Gostout CJ, McConico AL, Zielinski M, Bingener J. Natural orifice transluminal endoscopic surgery for patients with perforated peptic ulcer. Surg Endosc 2011; 26:1534-8. [PMID: 22179453 DOI: 10.1007/s00464-011-2063-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/09/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perforation accounts for 70% of deaths attributed to peptic ulcers. Laparoscopic repair is effective but infrequently used. Our aim was to assess how many patients with perforated peptic ulcer could be candidates for a transluminal endoscopic omental patch closure. METHODS This retrospective study reviewed patients with perforated peptic ulcer from 2005 to 2010. Demographics, ulcer characteristics, operative procedure, and outcomes were recorded. Candidates for endoscopic transluminal repair were defined as those having undergone omental patch closure of an ulcer of appropriate size and no contraindications to laparoscopy or endoscopy. RESULTS In the retrospective review, a total of 104 patients were identified; 62% female, mean age = 68 years, mean ASA of 3, and 63% medication-related ulcers. Fifty-nine (63%) had an omental patch (80% open), and 35 (37%) had other procedures. Ten patients had nonoperative management. Thirty-day mortality was 14% and 1 year mortality was 35%. Forty-nine patients (52%) were considered potential candidates for transluminal repair. CONCLUSION Sixty-three percent of our patients sustained a medication-related perforation with 1 year mortality of 35%. The majority of patients were treated using open omental patch repair. Transluminal endoscopic repair may provide an additional situation for a minimally invasive approach for a number of these patients.
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Affiliation(s)
- Eduardo A Bonin
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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13
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Bertleff MJOE, Lange JF. Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 2009; 24:1231-9. [PMID: 20033725 PMCID: PMC2869436 DOI: 10.1007/s00464-009-0765-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 11/05/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. METHODS An electronic literature search was done by using PubMed and EMBASE databases. Relevant papers written between January 1989 and May 2009 were selected and scored according to Effective Public Health Practice Project guidelines. RESULTS Data were extracted from 56 papers, as summarized in Tables 1-7. The overall conversion rate for laparoscopic correction of perforated peptic ulcer was 12.4%, with main reason for conversion being the diameter of perforation. Patients presenting with PPU were predominantly men (79%), with an average age of 48 years. One-third had a history of peptic ulcer disease, and one-fifth took nonsteroidal anti-inflammatory drugs (NSAIDs). Only 7% presented with shock at admission. There seems to be no consensus on the perfect setup for surgery and/or operating technique. In the laparoscopic groups, operating time was significant longer and incidence of recurrent leakage at the repair site was higher. Nonetheless there was significant less postoperative pain, lower morbidity, less mortality, and shorter hospital stay. CONCLUSION There are good arguments that laparoscopic correction of PPU should be first treatment of choice. A Boey score of 3, age over 70 years, and symptoms persisting longer than 24 h are associated with higher morbidity and mortality and should be considered contraindications for laparoscopic intervention.
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Affiliation(s)
- Mariëtta J O E Bertleff
- Department of Plastic and Reconstructive Surgery, Academic Hospital Maastricht, P.Debeyelaan 25, 6229 HX, Maastricht, The Netherlands.
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14
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Bertleff MJOE, Halm JA, Bemelman WA, van der Ham AC, van der Harst E, Oei HI, Smulders JF, Steyerberg EW, Lange JF. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg 2009; 33:1368-73. [PMID: 19430829 PMCID: PMC2691927 DOI: 10.1007/s00268-009-0054-y] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic surgery has become popular during the last decade, mainly because it is associated with fewer postoperative complications than the conventional open approach. It remains unclear, however, if this benefit is observed after laparoscopic correction of perforated peptic ulcer (PPU). The goal of the present study was to evaluate whether laparoscopic closure of a PPU is as safe as conventional open correction. METHODS The study was based on a randomized controlled trial in which nine medical centers from the Netherlands participated. A total of 109 patients with symptoms of PPU and evidence of air under the diaphragm were scheduled to receive a PPU repair. After exclusion of 8 patients during the operation, outcomes were analyzed for laparotomy (n = 49) and for the laparoscopic procedure (n = 52). RESULTS Operating time in the laparoscopy group was significantly longer than in the open group (75 min versus 50 min). Differences regarding postoperative dosage of opiates and the visual analog scale (VAS) for pain scoring system were in favor of the laparoscopic procedure. The VAS score on postoperative days 1, 3, and 7 was significant lower (P < 0.05) in the laparoscopic group. Complications were equally distributed. Hospital stay was also comparable: 6.5 days in the laparoscopic group versus 8.0 days in the open group (P = 0.235). CONCLUSIONS Laparoscopic repair of PPU is a safe procedure compared with open repair. The results considering postoperative pain favor the laparoscopic procedure.
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Affiliation(s)
- Mariëtta J O E Bertleff
- Department of Plastic and Reconstructive Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands.
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Wacha H. The role of the general surgeon and outcomes research. Surg Infect (Larchmt) 2008; 9:7-14. [PMID: 18363463 DOI: 10.1089/sur.2007.9973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannes Wacha
- Department of Surgery, Hospital zum heiligen Geist and Academic Teaching Hospital of the University of Frankfurt, Germany.
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