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Surgical Management of Perforated Peptic Ulcer: A Comparative Meta-analysis of Laparoscopic Versus Open Surgery. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:586-594. [PMID: 36044274 DOI: 10.1097/sle.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the widescale success of proton pump inhibitors to reducing the incidence of peptic ulcer disease, perforated peptic ulcer (PPU) remains a significant cause of severe complications and death. The implementation of open or surgical repair of PPU should be guided by reliable guidelines which are based on current systematic evidence. OBJECTIVES To assess the comparative efficacy and safety of laparoscopic and open repair of PPU. METHODS A systematic review and meta-analysis was conducted based on retrospective, prospective cohort studies, and randomized clinical trials. Duration of surgery and postoperative complications and death were collected from eligible studies, and the outcomes were pooled using mean differences (MD) or relative risks (RRs) for numerical and binary outcomes, respectively. The estimated variance was expressed as 95% confidence intervals (95% CIs). RESULTS Forty-five studies were included (8456 patients, 56.08% underwent open repair, 6 prospective studies, 7 randomized clinical trials, and 32 retrospective studies). Compared with open repair, laparoscopic surgeries were associated with longer operative times (MD=8.36, 95% CI, 0.49-16.22), shorter hospital stay (MD=-2.74, 95% CI, -3.70 to-1.79), a higher risk of suture leakage (RR=1.91, 95% CI, 1.04-3.49) and lower risks of mortality (RR=0.57, 95% CI, 0.47-0.70), septic shock (RR=0.69, 95% CI, 0.49-0.98), renal failure (RR=0.38, 95% CI, 0.18-0.79), and wound infection (RR=0.26, 95% CI, 0.19-0.37). CONCLUSION Laparoscopic repair of PPU showed promising safety outcomes; however, future well-designed randomized studies are warranted to reduce the observed performance bias and possible selection bias in individual studies.
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Arroyo Vázquez JA, Khodakaram K, Bergström M, Park PO. Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study. Surg Endosc 2020; 35:7183-7190. [PMID: 33258032 PMCID: PMC8599331 DOI: 10.1007/s00464-020-08158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
Background Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial. Methods All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2–3 weeks. Complications were recorded and classified according to Clavien-Dindo (C-D). Results 43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5 years (23–91) with no difference between groups. ASA score was unevenly distributed between the groups (p = 0.069). Operation time was significantly shorter in the stent group, 68 min (48–107) versus 92 min (68–154) (p = 0.001). Stents were removed after a median of 21 days (11–37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2–5) (n.s.). Conclusions Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment.
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Affiliation(s)
- Jorge Alberto Arroyo Vázquez
- Department of Surgery, South Älvsborg Hospital, Brämhultsvägen 53, 501 82, Borås, Sweden. .,University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Kaveh Khodakaram
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Bergström
- Department of Surgery, Halland Hospital, Varberg, Sweden.,University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Per-Ola Park
- Department of Surgery, Halland Hospital, Varberg, Sweden.,University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
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Koujalagi RS, Kenawadekar R, Gogate AS, Sunil TN. A 1-Year Randomized Controlled Study to Compare Laparoscopic Repair vs. Open Repair for the Treatment of Hollow Viscus Perforation. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhou C, Wang W, Wang J, Zhang X, Zhang Q, Li B, Xu Z. An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer. Sci Rep 2015; 5:13976. [PMID: 26350958 PMCID: PMC4563564 DOI: 10.1038/srep13976] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/12/2015] [Indexed: 02/08/2023] Open
Abstract
Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation.
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Affiliation(s)
- Chunhua Zhou
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Hangzhou First People's Hospital, Hangzhou, China
| | - Weizhi Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiwei Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyu Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,The Second People's Hospital of Huaian, Huaian, China
| | - Qun Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bowen Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
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Mallipedhi A, Prior SL, Dunseath G, Bracken RM, Barry J, Caplin S, Eyre N, Morgan J, Baxter JN, O'Sullivan SE, Sarmad S, Barrett DA, Bain SC, Luzio SD, Stephens JW. Changes in plasma levels of N-arachidonoyl ethanolamine and N-palmitoylethanolamine following bariatric surgery in morbidly obese females with impaired glucose homeostasis. J Diabetes Res 2015; 2015:680867. [PMID: 25874237 PMCID: PMC4385619 DOI: 10.1155/2015/680867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 02/07/2023] Open
Abstract
AIM We examined endocannabinoids (ECs) in relation to bariatric surgery and the association between plasma ECs and markers of insulin resistance. METHODS A study of 20 participants undergoing bariatric surgery. Fasting and 2-hour plasma glucose, lipids, insulin, and C-peptide were recorded preoperatively and 6 months postoperatively with plasma ECs (AEA, 2-AG) and endocannabinoid-related lipids (PEA, OEA). RESULTS Gender-specific analysis showed differences in AEA, OEA, and PEA preoperatively with reductions in AEA and PEA in females postoperatively. Preoperatively, AEA was correlated with 2-hour glucose (r = 0.55, P = 0.01), HOMA-IR (r = 0.61, P = 0.009), and HOMA %S (r = -0.71, P = 0.002). OEA was correlated with weight (r = 0.49, P = 0.03), waist circumference (r = 0.52, P = 0.02), fasting insulin (r = 0.49, P = 0.04), and HOMA-IR (r = 0.48, P = 0.05). PEA was correlated with fasting insulin (r = 0.49, P = 0.04). 2-AG had a negative correlation with fasting glucose (r = -0.59, P = 0.04). CONCLUSION Gender differences exist in circulating ECs in obese subjects. Females show changes in AEA and PEA after bariatric surgery. Specific correlations exist between different ECs and markers of obesity and insulin and glucose homeostasis.
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Affiliation(s)
- Akhila Mallipedhi
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
- Department of Diabetes & Endocrinology, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Sarah L. Prior
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Gareth Dunseath
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Richard M. Bracken
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Jonathan Barry
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Scott Caplin
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Nia Eyre
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - James Morgan
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - John N. Baxter
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
| | - Saoirse E. O'Sullivan
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby DE22 3DT, UK
| | - Sarir Sarmad
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - David A. Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Stephen C. Bain
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Steve D. Luzio
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
| | - Jeffrey W. Stephens
- Diabetes Research Group, Institute of Life Sciences, Swansea University, Swansea SA2 8PP, UK
- Department of Diabetes & Endocrinology, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL, UK
- *Jeffrey W. Stephens:
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