1
|
Uyama I, Shibasaki S, Inaki N, Ehara K, Oshiro T, Okabe H, Obama K, Kasama K, Kinoshita T, Kurokawa Y, Kojima K, Shiraishi N, Suda K, Takiguchi S, Tokunaga M, Naitoh T, Nagai E, Nishizaki M, Nunobe S, Fukunaga T, Hosoda K, Sano T, Sagawa H, Shindo K, Nakagawa M, Hiratsuka T. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Stomach. Asian J Endosc Surg 2024; 17:e13365. [PMID: 39245468 DOI: 10.1111/ases.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/04/2024] [Indexed: 09/10/2024]
Affiliation(s)
- Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | | | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa, Japan
| | - Kazuhisa Ehara
- Department of Gastrointestinal Surgery, Gastric Surgery Division, Saitama Cancer Center, Saitama, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Hiroshi Okabe
- Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazuyuki Kojima
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Mibu-machi, Japan
| | - Norio Shiraishi
- Department of General Surgery・Center for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Yushima, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Eishi Nagai
- Department of Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Souya Nunobe
- Department of Gastric Surgery, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Kei Hosoda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Sano
- The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Hiroyuki Sagawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Nakagawa
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Mibu-machi, Japan
| | - Takahiro Hiratsuka
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| |
Collapse
|
2
|
Abouelazayem M, Jain R, Wilson MSJ, Martinino A, Balasubaramaniam V, Biffl W, Coccolini F, Riera M, Wadhawan H, Wazir I, Abderaouf B, Abramov D, Abu Jayyab MA, Al-Shami K, Alfarwan A, Alhajami FM, Alkaseek A, Alozairi O, Ammar AS, Atar B, Baatarjav GE, Bains L, Bakri A, Bayramov N, Bhojwani R, Brachini G, Calini G, Campanelli M, Cheng SY, Choudhary CS, Chowdhury S, Colak E, Das JK, Dawani S, Dönmez T, Elzayat I, Erdene S, Faizi TQ, Frountzas M, Gafsi B, Gentileschi P, Guler M, Gupta G, Harkati NE, Harris M, Hasan DM, Irowa OO, Jafferi S, Jain SA, Jun Han L, Kandiboyina SM, Karabulut M, Khamees A, Khan S, Khan MM, Khaw CJ, Kisielewski M, Klib M, Košir JA, Krawczyk WJ, Lisi G, Makama JG, Maqbool B, Marques CN, Meric S, Mietła MP, Ads AM, Muhumuza J, Mulita F, Mustafayeva M, Omar MA, Omarov T, Pathak AA, Paul R, Pavone G, Podda M, Raja Ram NK, Rauf F, Rauf S, Safy AM, Sandag E, Şanlı AN, Siddiqui AZ, Sotiropoulou M, Talib V, Tatar C, Thota A, Tokocin M, Tolat A, Uchikov PA, Valenzuela JI, Venkatappa SK, Verras GI, Vlahović I, Zreeg DAS, Cardoso VR, Gkoutos GV, Singhal R, Mahawar K. Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study. Surg Endosc 2024:10.1007/s00464-024-10881-0. [PMID: 38886232 DOI: 10.1007/s00464-024-10881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
Collapse
Affiliation(s)
- Mohamed Abouelazayem
- Department of Surgery, University College London Hospitals, London, UK.
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.
- , General Surgery, University College Hospital, UCLH Contact Centre, Ground Floor North, 250 Euston Road, London, NW1 2PG, UK.
| | - Rajesh Jain
- Shrewsbury & Telford Hospital NHS Trust, Shrewsbury, UK
| | | | | | | | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Himanshu Wadhawan
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | | | | | - Daniil Abramov
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | | | | | | | | | | | | | | | - Burak Atar
- Bakırköy Training and Research Hostpital, Bakirkoy, Turkey
| | | | | | | | | | | | - Gioia Brachini
- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giacomo Calini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michela Campanelli
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | - Turgut Dönmez
- Bakırköy Training and Research Hospital, Bakirkoy, Turkey
| | | | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, Athens, Greece
| | - Besma Gafsi
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mert Guler
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Salman Jafferi
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | | | | | | | | | | | - Shahzeb Khan
- MTI Khyber Teaching Hospital, Peshawar, Pakistan
| | | | | | | | | | | | - Wiktor Jan Krawczyk
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome, Italy
| | | | | | | | - Serhat Meric
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mateusz Przemysław Mietła
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Matanat Mustafayeva
- Scientific Center of Surgery After Named M.A.Topchubashov, Azerbaijan, Azerbaijan
| | - Mohammed A Omar
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | | | | | | | | | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fatima Rauf
- Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Sidra Rauf
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Ahmed Mohamed Safy
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Erdene Sandag
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Vikash Talib
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | - Cihad Tatar
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Anuroop Thota
- NRI Medical College, General & Superspeciality Hospital, Chinakakani, India
| | - Merve Tokocin
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Ivan Vlahović
- Department of Surgery, Clinical Hospital Center Osijek, University of Osijek, Osijek, Croatia
| | | | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, University of Sunderland, Sunderland, UK
| |
Collapse
|
3
|
Wadewitz E, Friedrichs J, Grilli M, Vey J, Zimmermann S, Kleeff J, Ronellenfitsch U, Klose J, Rebelo A. Approaches for the treatment of perforated peptic ulcers: a network meta-analysis of randomised controlled trials - study protocol. BMJ Open 2024; 14:e082732. [PMID: 38503410 PMCID: PMC10953088 DOI: 10.1136/bmjopen-2023-082732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Perforated peptic ulcers are a life-threatening complication associated with high morbidity and mortality. Several treatment approaches are available. The aim of this network meta-analysis (NMA) is to compare surgical and alternative approaches for the treatment of perforated peptic ulcers regarding mortality and other patient-relevant outcomes. METHODS AND ANALYSIS A systematic literature search of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov trial registry and ICTRP will be conducted with predefined search terms.To address the question of the most effective treatment approach, an NMA will be performed for each of the outcomes mentioned above. A closed network of interventions is expected. The standardised mean difference with its 95% CI will be used as the effect measure for the continuous outcomes, and the ORs with 95% CI will be calculated for the binary outcomes. ETHICS AND DISSEMINATION In accordance with the nature of the data used in this meta-analysis, which involves aggregate information from previously published studies ethical approval is deemed unnecessary. Results will be disseminated directly to decision-makers (eg, surgeons, gastroenterologists) through publication in peer-reviewed journals and presentation at conferences. PROSPERO REGISTRATION NUMBER CRD42023482932.
Collapse
Affiliation(s)
- Elisabeth Wadewitz
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Juliane Friedrichs
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle (Saale), Germany
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim, Heidelberg University, Mannheim, German, Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
| | - Johannes Vey
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Samuel Zimmermann
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg Kleeff
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Johannes Klose
- University Hospital Halle (Saale), Germany, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle Wittenberg, Halle, Germany
| | | |
Collapse
|
4
|
Giles T, Bull N, Burnett D. How to do laparoscopic repair of perforated anterior duodenal ulcers: a 'three arches' falciform patch technique simplifies the approach. ANZ J Surg 2024; 94:467-471. [PMID: 38071489 DOI: 10.1111/ans.18806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 03/20/2024]
Abstract
Laparoscopic repair of perforated duodenal ulcers has proven superior results to open procedures though uptake has been poor. We describe the 'three arches' technique as a means of reducing technical difficulty and improving operative efficiency. Our case series of patients undergoing this technique for perforated peptic ulcer disease demonstrates comparable results to other methods of repair.
Collapse
Affiliation(s)
- Thomas Giles
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nicholas Bull
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - David Burnett
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
5
|
Panin SI, Sazhin VP. Improvement of Russian clinical guidelines and reduction of mortality in perforated ulcers. Khirurgiia (Mosk) 2024:5-13. [PMID: 38344955 DOI: 10.17116/hirurgia20240215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To analyze the results of laparoscopic surgery in patients with perforated ulcers using evidence-based medicine approaches. MATERIAL AND METHODS We compared the efficacy and effectiveness of laparoscopic and open surgeries in patients with perforated ulcers. Meta-analysis of mortality after laparoscopic surgeries (randomized controlled trials) and trial sequential analysis were carried out. RESULTS We clarified the differences between the efficacy and effectiveness of laparoscopic surgeries regarding postoperative mortality. In the Russian Federation, mortality after laparoscopic surgery is 9-11 times lower compared to open procedures. According to evidence-based researches (efficacy of laparoscopic interventions in 10 meta-analyses), these differences are less obvious (1.4-3.0 times) and not significant. The diversity-adjusted required information size to draw reasonable conclusions about differences in mortality in trial sequential analysis was 68 181 participants. Meta-analyses of RCTs also demonstrate lower incidence of wound complications (1.8-5.0% after laparoscopic surgery and 6.3-13.3% after laparotomy), shorter hospital-stay (mean difference from -0.13 to -2.84) and less severe pain syndrome (mean difference in VAS score from -2.08 to -2.45) after laparoscopic technologies. CONCLUSION The obvious advantage of laparoscopic surgery in patients with perforated ulcers is fast-truck recovery following shorter hospital-stay, mild pain and rarer wound complications. Comparison of postoperative mortality regarding efficacy and effectiveness is difficult due to insufficient introduction of laparoscopic technologies in clinical practice and diversity-adjusted required information size.
Collapse
Affiliation(s)
- S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - V P Sazhin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Ryazan State Medical University, Ryazan, Russia
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Tsao LC, Lin J, Lin KH, Ng SY, Huang CY, Hung YJ, Wu SC, Gao SL, Yu SF, Lin CC, Chang WJ. Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease. Sci Rep 2023; 13:1170. [PMID: 36670125 PMCID: PMC9860010 DOI: 10.1038/s41598-023-27471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution's prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.
Collapse
Affiliation(s)
- Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan
| | - Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Department of Animal Science and Biotechnology, Tunghai University, Taichung, 407, Taiwan
- Department of General Surgery, Yuanlin Christian Hospital, Yuanlin, 510, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Sze-Yuin Ng
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Cheng-Yen Huang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Szu-Chia Wu
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shih-Ling Gao
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shu-Fen Yu
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Chi-Chien Lin
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan.
- Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan.
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Wei-Jung Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan.
| |
Collapse
|
8
|
Odisho T, Shahait AA, Sharza J, Ali AA. Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital. Surg Endosc 2023; 37:715-722. [PMID: 35562508 PMCID: PMC9105587 DOI: 10.1007/s00464-022-09306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Minimally invasive or open Graham Patch repair remains the gold standard approach for management of perforated peptic ulcers (PPU). Herein, we report outcomes of laparoscopic technique and compare it with open approach at a community hospital. METHODS Retrospective observational study conducted comparing laparoscopic modified Cellan-Jones repair (mCJR) versus the standard open repair of PPU. Patients aged 18-90 years during 2016-2021 were offered either a minimally invasive or open approach depending on surgeon laparoscopic capability, and were compared in terms of demographics, co-morbidities, intra-operative details, and short-term outcomes. RESULTS A total of 49 patients were included (46.9% males, mean age 52.9 years, mean BMI 25.0, ASA ≥ III 75.5%, 75.5% smokers, 26.5% current NSAIDs use, and 71.4% alcohol drinkers). Duodenum was the most common perforation site (57.1%), and majority of ulcers were 1-2 cm (72.9%). Laparoscopic approach was performed in 16 consecutive patients (32.7%) by a single surgeon, with no conversions. Preoperative characteristics were similar for both groups. Compared to open approach, laparoscopic group were taken to operation immediately (< 4 h) (87.5% vs. 15.2%, p < 0.001), had lower estimated blood loss (11.8 ml vs. 73.8 ml, p = 0.063), and longer operative time (117.1 min vs. 85.6 min, p = 0.010). Postoperatively, nasogastric tube was removed earlier in laparoscopic group (POD1-2, 87.5% vs. 24.2%, p = 0.001), with earlier resumption of diet (POD1-2, 62.6% vs. 9.1%, p = 0.002), less narcotic usage (< 3 days, 58.3% vs. 6.1%, p < 0.001), earlier return of bowel function (POD1-2, 43.8% vs. 9.1%, p = 0.003) and shorter length of stay (LOS) (3.7 days vs. 16.1 days, p < 0.001). Both in-house mortality and morbidity rates were lower in the laparoscopic group, but not statistically significant [(0% vs. 6.1%, p = 0.347) and (12.5% vs. 39.4%, p = 0.500), respectively]. CONCLUSION Laparoscopic mCJR is a feasible method for repair of PPU, and it is associated with shorter LOS, and less narcotics usage in comparison to the open repair approach.
Collapse
Affiliation(s)
- Tanya Odisho
- Department of Surgery, Sinai Grace Hospital, Detroit Medical Center, Detroit, MI, USA.
| | - Awni A. Shahait
- grid.413184.b0000 0001 0088 6903Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI USA
| | - Jared Sharza
- grid.461059.f0000 0004 0419 4674University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Abubaker A. Ali
- grid.413184.b0000 0001 0088 6903Department of Surgery, Sinai Grace Hospital, Detroit Medical Center, Detroit, MI USA ,grid.413184.b0000 0001 0088 6903Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI USA
| |
Collapse
|
9
|
A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer. J Trauma Acute Care Surg 2023; 94:e1-e13. [PMID: 36252181 DOI: 10.1097/ta.0000000000003799] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. METHODS PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. RESULTS There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, -2.84 days; 95% CI, -3.63 to -2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). CONCLUSION Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level IV.
Collapse
|
10
|
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.
Collapse
|
11
|
Kim CW, Kim JW, Yoon SN, Oh BY, Kang BM. Laparoscopic repair of perforated peptic ulcer: a multicenter, propensity score matching analysis. BMC Surg 2022; 22:230. [PMID: 35710415 PMCID: PMC9205025 DOI: 10.1186/s12893-022-01681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Perforated peptic ulcer (PPU) is a common emergency condition requiring surgery using laparoscopy or open repair of the perforated site. The aim of this study was to assess the role of laparoscopic surgery (LS) based on the safety and efficacy for PPU. Methods Medical records of the consecutive patients who underwent LS or open surgery (OS) for PPU at five hospitals between January 2009 and December 2019 were retrospectively reviewed. After propensity score matching, short-term perioperative outcomes were compared between LS and OS in selected patients. Results Among the 598 patients included in the analysis, OS was more frequently performed in patients with worse factors, including older age, a higher American Society of Anesthesiologists score, more alcohol use, longer symptom duration, a higher Boey score, a higher serum C-reactive protein level, a lower serum albumin level, and a larger-diameter perforated site. After propensity score matching, 183 patients were included in each group; variables were well-balanced between-groups. Postoperative complications were not different between groups (24.6% LS group vs. 31.7% OS group, p = 0.131). However, postoperative length of hospital stay (10.03 vs. 12.53 days, respectively, p = 0.003) and postoperative time to liquid intake (3.75 vs. 5.26 days, p < 0.001) were shorter in the LS group. Conclusions LS resulted in better functional recovery than OS and can be safely performed for treatment of PPU. When performed by experienced surgeons, LS is an alternative option, even for hemodynamically unstable patients.
Collapse
Affiliation(s)
- Chang Woo Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Nam Yoon
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Bo Young Oh
- Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, 24253, Chuncheon, Korea.
| |
Collapse
|
12
|
Martinino A, Bhandari M, Abouelazayem M, Abdellatif A, Koshy RM, Mahawar K. Perforated Marginal Ulcer After Gastric Bypass for Obesity: A Systematic Review. Surg Obes Relat Dis 2022; 18:1168-1175. [DOI: 10.1016/j.soard.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
|
13
|
Sawada R, Watanabe K, Tokumine J, Lefor AK, Ando T, Yorozu T. Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery: A case report. World J Clin Cases 2022; 10:2357-2362. [PMID: 35321172 PMCID: PMC8895180 DOI: 10.12998/wjcc.v10.i7.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/18/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves. This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block. The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.
CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair. Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1% lidocaine 20 mL. The pain was relieved after the block. The diagnosis was anterior cutaneous nerve entrapment syndrome. Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.
CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.
Collapse
Affiliation(s)
- Ryuji Sawada
- Department of Pain Clinic, NTT Medical Center Tokyo, Higashigotanda 141-8625, Tokyo, Japan
| | - Kunitaro Watanabe
- Department of Anesthesiology, Hino Municipal Hospital, Tamadaira 191-0062, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka 181-8611, Tokyo, Japan
| |
Collapse
|
14
|
MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation. Tomography 2022; 8:667-687. [PMID: 35314633 PMCID: PMC8938822 DOI: 10.3390/tomography8020056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.
Collapse
|
15
|
Ukhanov AP, Zakharov DV, Zhilin SA, Bolshakov SV, Kochetygov DV, Leonov AI, Muminov KD, Aselderov YA. [Emergency laparoscopy in the treatment of perforated gastroduodenal ulcers]. Khirurgiia (Mosk) 2022:61-67. [PMID: 36469470 DOI: 10.17116/hirurgia202212161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To compare the results of endoscopic and open treatment of perforated gastroduodenal ulcers. MATERIAL AND METHODS There were 445 patients with perforated gastroduodenal ulcers between 2013 and 2021. Endoscopic suturing of perforation was performed in 172 patients (38.7%), 273 ones underwent open surgery. RESULTS Among 172 patients scheduled for endoscopy, 160 (93.6%) ones underwent laparoscopic suturing of perforation. Morbidity rate was 5.0% (n=8), postoperative mortality rate - 1.3% (n=2). Comparison of the outcomes after laparoscopic suturing of ulcers in 160 patients and open surgery in 134 patients showed that laparoscopy was followed by 2.5 times lower incidence of complications and 3 times lower postoperative mortality. CONCLUSION Diagnostic laparoscopy is advisable in patients with perforated ulcers and no contraindications. In most cases, surgery can be successfully and effectively completed without conversion to laparotomy. Endoscopic closure of ulcerative defect is preferable since this procedure has certain advantages over traditional intervention, contributes to significant reduction in morbidity, mortality and hospital-stay.
Collapse
Affiliation(s)
- A P Ukhanov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Institute of Medical Education of the Yaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | - D V Zakharov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Institute of Medical Education of the Yaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | - S A Zhilin
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Institute of Medical Education of the Yaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
| | - S V Bolshakov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - D V Kochetygov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - A I Leonov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - K D Muminov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - Yu A Aselderov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| |
Collapse
|
16
|
Yawar B, Marzouk AM, Ali H, Ghorab TM, Asim A, Bahli Z, Abousamra M, Diab A, Abdulrahman H, Asim AE, Fleville S. Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes. Cureus 2021; 13:e19618. [PMID: 34804752 PMCID: PMC8597679 DOI: 10.7759/cureus.19618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 01/11/2023] Open
Abstract
Background Perforated peptic ulcer disease (PUD) is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in the presentation of patients with perforated ulcers. Here we present this study from our experience in a Northern Irish acute district hospital. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with the incidence of perforated peptic ulcers. Follow-up data were also collected. Seasons were defined as per UK Met Office. Results A total of 50 patients presented with perforated PUD. Male to female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. Fourteen patients (28%) were either very frail or had contained perforations and were conservatively managed. Three deaths were noted (6%). Thirteen patients (26%) required ICU admission at some stage in their management. Conclusion Slight seasonal variation was noted in the presentation of perforated peptic ulcers in our study with a higher incidence in the winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.
Collapse
Affiliation(s)
- Bakhat Yawar
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Ahmed M Marzouk
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Heba Ali
- Radiology, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Tamer M Ghorab
- Radiology, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Ayeisha Asim
- Geriatrics, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Zahid Bahli
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Mohammad Abousamra
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Alsarah Diab
- General Surgery, The Northern Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Antrim Area Hospital), Antrim, GBR
| | - Hassan Abdulrahman
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Asim E Asim
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| | - Samara Fleville
- General Surgery, The Western Trust Health & Social Care Jobs in Northern Ireland (HSCNI) (Altnagelvin Area Hospital), Derry/Londonderry, GBR
| |
Collapse
|
17
|
Pelloni M, Afonso-Luís N, Marchena-Gomez J, Piñero-González L, Ortíz-López D, Acosta-Mérida MA, Rahy-Martín A. Comparative study of postoperative complications after open and laparoscopic surgery of the perforated peptic ulcer: Advantages of the laparoscopic approach. Asian J Surg 2021; 45:1007-1013. [PMID: 34593282 DOI: 10.1016/j.asjsur.2021.08.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite the acceptance of the laparoscopic approach for the treatment of perforated peptic ulcers, its definitive implantation is still a matter of discussion. We performed a comparative study between the open and laparoscopic approach focused on postoperative surgical complications. METHODS Retrospective observational study in which patients operated on for perforated peptic ulcus in our center between 2001 and 2017 were analyzed. Only those in whom suture and/or omentoplasty had been performed were selected, either for open or laparoscopic approach. Demographic, clinical, and intraoperative variables, complications, mortality and length of stay were collected. Both groups, open and laparoscopic surgery patients, were compared. RESULTS The final study sample was 250 patients, 190 (76%) men and 60 (24%) women, mean age 54 years (SD ± 16.7). In 129 cases (52%), the surgical approach was open, and in 121 (48%) it was laparoscopic. Grades III-V complications of the Clavien-Dindo Classification occurred in 23 cases (9%). Operative mortality was 1.2% (3 patients). Laparoscopically operated patients had significantly fewer complications (p = 0.001) and shorter hospital stay (p < 0.001). In multivariate analysis, laparoscopic approach (p = 0.025; OR:0.45-95%CI: 0.22-0.91), age (p = 0.003; OR:1.03-95%CI: 1.01-1.06), and Boey score (p = 0.024 - OR:1.71 - CI95%: 1.07-2.72), were independent prognostic factors for postoperative surgical complications. CONCLUSION Laparoscopic surgery should be considered the first-choice approach for patients with perforated peptic ulcer. It is significantly associated with fewer postoperative complications and a shorter hospital stay than the open approach.
Collapse
Affiliation(s)
- Maria Pelloni
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Natalia Afonso-Luís
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Joaquin Marchena-Gomez
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Luís Piñero-González
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - David Ortíz-López
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Asunción Acosta-Mérida
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aida Rahy-Martín
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
18
|
Comparison of laparoscopic and conventional graham’s omentopexy in peptic ulcer perforation: A single center experience. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.917335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Kim HI, Cho YJ, Yeom JH, Jeon WJ, Kim MG. Perforation on the superior side of duodenum is a risk factor of laparoscopic primary repair for duodenal ulcer perforation. Ann Surg Treat Res 2021; 100:228-234. [PMID: 33854992 PMCID: PMC8019982 DOI: 10.4174/astr.2021.100.4.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation. Methods Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed. Results All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure. Conclusion Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.
Collapse
Affiliation(s)
- Hyun Il Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Yu Jeong Cho
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Jong Hoon Yeom
- Department of Anesthesiology, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
Open Versus Laparoscopic Repair of Perforated Peptic Ulcer Disease: A Propensity-matched Study of the National Emergency Laparotomy Audit. Ann Surg 2020; 275:928-932. [PMID: 33201117 DOI: 10.1097/sla.0000000000004332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare open surgery (OS) with laparoscopic surgery (LS) for perforated peptic ulcer (PPU) disease using a National dataset BACKGROUND:: PPU disease is typically treated surgically with an omental patch. This can be performed through OS or a LS. Current evidence in OS versus LS suggests equivalence in mortality and postoperative complications, but a decrease in pain and wound infections with LS. METHODS A one-to-one propensity score-matched analysis of patients who underwent PPU repair from December 2013 to December 2017 using data from the National Emergency Laparotomy Audit was performed. Patients with an initially laparoscopic approach were classed as LS even if converted to OS. The primary end-point was 90-day mortality; secondary endpoints were length of stay (LOS), re-operation, and re-admission to critical care. Multivariable logistic and linear models were created to compare the effect of operative approach on binary and continuous outcomes with log-rank tests for time-to-event data. RESULTS A total of 5253 patients underwent surgery in the study period. After propensity-matching, 2 groups of 1158 patients were created. Overall 90-day mortality was 7.5%. There was no difference between the LA and OA for 90-day mortality (7.2% vs 8.5%, OR 0.80, 95% CI 0.56-1.15, P = 0.23), median LOS (equivalent at 7 days, P = 0.09), reoperation (3.6% vs 4.0%, P = 0.74), or re-admission to critical care (2.8% vs 2.9%, P = 0.92). Across the 4-year study period LS use increased from 20% to 26% and the conversion rate decreased from 40% to 31%. CONCLUSIONS Short outcomes from laparoscopic PPU repair appear equivalent to open repair. There is increasing adoption of LS with decreasing conversion rates. LS for PPU appears to be an acceptable approach in this setting.
Collapse
|
22
|
Abstract
Gastroduodenal perforation may be spontaneous or traumatic and the majority of spontaneous perforation is due to peptic ulcer disease. Improved medical management of peptic ulceration has reduced the incidence of perforation, but still remains a common cause of peritonitis. The classic sub-diaphragmatic air on chest x-ray may be absent and computed tomography scan is a more sensitive investigation in the stable patient. The management of perforated peptic ulcer disease is still a subject of debate. The majority of perforated peptic ulcers are caused by Helicobacter pylori, so definitive surgery is not usually required. Perforated peptic ulcer is an indication for operation in nearly all cases except when the patient is asymptomatic or unfit for surgery. However, non-operative management has a significant incidence of intra-abdominal abscesses and sepsis. Primary closure is achievable in traumatic perforation, but the management follows the Advanced Trauma Life Support (ATLS) principles.
Collapse
Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| |
Collapse
|
23
|
Murad MF, Khan R, Tariq M, Akram A, Merrell RC, Zafar A. Laparoscopy: A Better Approach for Perforated Duodenal Ulcer. Cureus 2020; 12:e10953. [PMID: 33209516 PMCID: PMC7667608 DOI: 10.7759/cureus.10953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Laparoscopic surgery is becoming the gold standard for most abdominal surgeries in recent times. Laparoscopic repair of perforated duodenal ulcer (PDU), however, is still an area of debate. The purpose of this study was to evaluate the safety and efficacy of laparoscopic repair of PDU versus open repair. Methods In this cross-sectional study, patients were consecutively sampled. Out of 101 patients with clinically diagnosed PDU, 36 patients underwent laparoscopic Graham patch repair and 65 underwent open Graham patch repair in a tertiary care academic hospital. Open repair was via upper midline incision, and laparoscopic repair by the three-port technique. The following stages were calculated: operative time, duration of postoperative analgesia, time taken to mobilize, and patient length of stay after the operation. Results The mean operative time was somewhat longer in the laparoscopy group compared to the open repair group (74.01 vs 56.17 minutes, respectively). Mean postoperative analgesia requirement, time taken to mobilize, and hospital stay were significantly shorter after laparoscopy than after open repair (1.21 days, 9.32 hours, and 3.12 days vs 3.83 days, 16.20 hours, and 4.85 days, respectively). Three patients (8%) in the laparoscopy group and 35 (54%) in the open repair group had postoperative complications. Conclusions Laparoscopic repair of PDU is a safe approach and better than open repair in terms of operative time with the right level of expertise only, postoperative analgesia requirement, mobilization, duration of hospital stay, and incidence of postoperative respiratory and wound complications.
Collapse
Affiliation(s)
| | - Rafeya Khan
- Surgery, Holy Family Hospital, Rawalpindi, PAK
| | - Maham Tariq
- Surgery, Holy Family Hospital, Rawalpindi, PAK
| | - Ayesha Akram
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Asif Zafar
- Surgery, Al Nafees Medical College and Hospital, Islamabad, PAK
| |
Collapse
|
24
|
Technical Evidence Review for Emergency Major Abdominal Operation Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. J Am Coll Surg 2020; 231:743-764.e5. [PMID: 32979468 DOI: 10.1016/j.jamcollsurg.2020.08.772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
|
25
|
Lee MJ, Coe PO, O'Donoghue R, Peirson M, Saha A. Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review. Br J Surg 2020; 107:1570-1579. [PMID: 32671830 DOI: 10.1002/bjs.11771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The ability to compare findings across surgical research is important. Inadequate description of participants, interventions or outcomes could lead to bias and inaccurate assessment of findings. The aim of this study was to assess consistency of description of participants using studies comparing laparoscopic and open repair of peptic ulcer as an example. METHODS This systematic review is reported in line with the PRISMA checklist. Searches of MEDLINE and Embase databases were performed to identify studies comparing laparoscopic and open repair of perforated peptic ulcer in adults, published in the English language. Manuscripts were dual-screened for eligibility. Full texts were retrieved and dual-screened for inclusion. Data extracted from studies included descriptors of participants in studies from tables and text. Descriptors were categorized into conceptual domains by the research team, and coverage of each domain by study was tabulated. RESULTS Searches identified 2018 studies. After screening, 37 full texts were retrieved and 23 studies were included in the final synthesis. A total of 76 unique descriptors were identified. These were classified into demographics (11 descriptors), vital signs (9 descriptors), disease-specific characteristics (10 descriptors), presentation and pathway factors (4 descriptors), risk factors (8 descriptors), laboratory tests (14 descriptors) and baseline health (28 descriptors). The number of descriptors in a single study ranged from three to 31. All studies reported at least one demographic descriptor. Laboratory tests was the least frequently described domain. CONCLUSION Study participants are described inconsistently in studies of a single example surgical condition.
Collapse
Affiliation(s)
- M J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P O Coe
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - M Peirson
- Department of General Surgery, Ysbyty Gwynedd Hospital, Bangor, UK
| | - A Saha
- Department of General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| |
Collapse
|
26
|
Sazhin AV, Ivakhov GB, Stradymov EA, Petukhov VA, Titkova SM. [Comparison of laparoscopic and open suturing of perforated peptic ulcer complicated by advanced peritonitis]. Khirurgiia (Mosk) 2020:13-21. [PMID: 32271732 DOI: 10.17116/hirurgia202003113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To compare the results of open and laparoscopic interventions for PGDU complicated by advanced peritonitis. MATERIAL AND METHODS A retrospective analysis enrolled 172 patients with PGDU who underwent surgery for the period 2014-2016. The research was performed at the bases of the Department of Faculty-Based Surgery No. 1 of the Medical Faculty of the Pirogov Russian National Research Medical University. Further analysis enrolled 138 patients in accordance with inclusion and exclusion criteria (laparoscopic intervention - 116 patients, open surgery - 22). Propensity score matching (pseudorandomization) was applied after comparative analysis of patients' characteristics and treatment outcomes in order to ensure maximum comparability of both groups. RESULTS Length of hospital-stay (7.1 vs. 9.8 days), incidence of extra-abdominal complications (6.3%. vs. 41.2%) and adverse events Clavien-Dindo grade II (6.3% vs. 35.3%) were significantly lower after minimally invasive surgery (p<0.05). CONCLUSION Analysis of comparable groups of patients with PGDU complicated by peritonitis revealed that laparoscopic surgery is accompanied by significantly lower incidence of extra-abdominal postoperative complications and shorter hospital-stay compared with open surgery. Mortality and incidence of intra-abdominal postoperative complications were similar in both groups.
Collapse
Affiliation(s)
- A V Sazhin
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - G B Ivakhov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - E A Stradymov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - V A Petukhov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - S M Titkova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
27
|
|
28
|
Zogovic S, Bojesen AB, Andos S, Mortensen FV. Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality (a nationwide prospective cohort study). Int J Surg 2019; 72:47-54. [PMID: 31639454 DOI: 10.1016/j.ijsu.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. MATERIALS AND METHODS This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. RESULTS The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HR = 0.48, 95% CI: 0.36-0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HR = 0.82, 95% CI: 0.59-1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. CONCLUSIONS Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.
Collapse
Affiliation(s)
- Sergej Zogovic
- Surgical Department, Hospital of Southern Jutland, Aabenraa, Denmark.
| | | | - Shadi Andos
- Surgical Department, Hospital of Southern Jutland, Aabenraa, Denmark.
| | | |
Collapse
|
29
|
Aldohuky W, Mohammed AA. Scrotal abscess as a manifestation of posterior duodenal perforation; a very rare presentation. Urol Case Rep 2019; 27:101010. [PMID: 31516837 PMCID: PMC6734181 DOI: 10.1016/j.eucr.2019.101010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022] Open
Abstract
Posterior perforation of duodenal ulcers is very rare; the infection may spread from the retroperitoneal space to the scrotum. A 75-year-old male presented with painful right scrotal swelling for 2 days associated with fever. During abdominal examination there was abdominal tenderness and scrotal swelling and tenderness. CT scan of the abdomen showed large amount of air collection in the retroperitoneal space extending to the right scrotum with contrast media passing to the retroperitoneum and right scrotum. Laparotomy done and there was a perforation in the posterior wall of the duodenum, suturing done and right scrotal abscess drained.
Collapse
Affiliation(s)
- Wan Aldohuky
- Duhok Directorate General of Health, Azadi Teaching Hospital, Duhok City, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- University of Duhok, College of Medicine, Department of Surgery, Duhok City, Kurdistan Region, Iraq
| |
Collapse
|
30
|
Laproscopic treatment for small bowel bleeding after detection by double-balloon endoscopy: A case report. Int J Surg Case Rep 2019; 59:63-65. [PMID: 31108451 PMCID: PMC6526289 DOI: 10.1016/j.ijscr.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/02/2019] [Indexed: 01/14/2023] Open
Abstract
The frequency of small bowel bleeding due to an arteriovenous malformation is rare. Localization of the bleeding location is required prior to laparoscopic resection. Double-balloon endoscopy enabled direct observation and preoperative tattooing. Endoscopic marking followed by laparoscopic resection might be optimal option.
Introduction The frequency of small bowel bleeding is relatively low and the process for the diagnosis and treaVtment remains difficult. Here, we report a case of massive small bowel bleeding due to arteriovenous malformation (AVM), treated by a combination of double-balloon endoscopy and laparoscopic resection. Presentation of Case A 59-year-old man was admitted to our hospital due to a hemorrhagic stool. The patient presented transient hemorrhagic shock and contrast-enhanced CT revealed a hyper-vascularized tumor in the small bowel. India ink tattooing for the responsible lesion with double-balloon endoscopy was performed. The tattooed lesion was easily confirmed during the subsequent laparoscopic observation and segmental resection was done. Pathological examination showed arteriovenous malformation of the small bowel. Discussion Prior to laparoscopic resection, the localization of the responsible area might be a significant consideration when the lesion is invisible. Endoscopic marking with DBE enables intraluminal detection and laparoscopic observation from the serosal side. Conclusion Preoperative marking with the use of double-balloon endoscopy followed by laparoscopic resection might be an optimal option for the treatment of massive small intestinal bleeding.
Collapse
|
31
|
Perforated Peptic Ulcer Surgery: Decreased Length of Stay but No Difference in Mortality with Laparoscopic Repair. Surg Laparosc Endosc Percutan Tech 2019; 28:410-415. [PMID: 30312196 DOI: 10.1097/sle.0000000000000584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) surgery mortality ranges 1% to 24%. We hypothesized a decrease in length of stay (LOS) with laparoscopic surgical repair (LSR) compared with open surgical repair (OSR). METHODS Patients undergoing PPU surgery 2005 to 2015 were identified in NSQIP. LSR was compared with OSR 2005 to 2015. LSR 2005 to 2010 was compared with 2011 to 2015. OSR 2005 to 2010 was compared with 2011 to 2015. The primary outcome was LOS. Secondary outcomes were mortality and morbidity. RESULTS Between 2005 and 2015, LSR had a decreased LOS, was more likely to wean from the ventilator, but had no significant difference in mortality compared with OSR. There was no significant difference in mortality for LSR or OSR over time. CONCLUSIONS When patients are appropriately selected, LSR for PPU is a viable alternative to OSR, decreasing LOS and pulmonary complications. This demonstrates significant benefit to patients and hospital throughput.
Collapse
|
32
|
Johnson CHN, McLean RC, McCallum I, Perren D, Phillips AW. An evaluation of the epidemiology, management and outcomes for perforated peptic ulcers across the North of England over 15 years: A retrospective cohort study. Int J Surg 2019; 64:24-32. [DOI: 10.1016/j.ijsu.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
|
33
|
Smith RS, Sundaramurthy SR, Croagh D. Laparoscopic versus open repair of perforated peptic ulcer: A retrospective cohort study. Asian J Endosc Surg 2019; 12:139-144. [PMID: 29806098 DOI: 10.1111/ases.12600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Perforated peptic ulcer disease (PPU) is a condition subject to wide geographical variations in incidence. It remains a significant cause of morbidity and mortality, even in the era of Helicobacter pylori eradication and proton-pump inhibitor therapy. There is no clear consensus on whether laparoscopic or open approaches are superior, and with most studies in this area originating from Europe and Asia, Australian data addressing this issue are lacking. METHODS This retrospective cohort study included all patients who underwent surgery for PPU within a hospital network in Australia. Baseline variables and primary outcomes, including length of hospital stay, chest and abdominal complications, and mortality, were recorded. Secondary outcomes, including reasons for conversion, were also considered. RESULTS In total, 109 patients underwent operations for PPU between January 2011 and December 2015. There were no significant differences with regard to baseline comorbidities. There were no statistically significant differences in terms of median length of hospital stay or rates of chest and abdominal complications, but the operative time was 28.5 min longer (P = <0.001) in the laparoscopic group than in the open group. CONCLUSION Open operations were faster to perform than laparoscopic operations for repair of PPU. Despite increased experience treating many surgical diseases laparoscopically, this study did not find it to be superior in terms of length of hospital stay or complication rates.
Collapse
Affiliation(s)
- Rohan Stuart Smith
- Department of Upper Gastrointestinal/Hepatopancreaticobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | | | - Daniel Croagh
- Department of Upper Gastrointestinal/Hepatopancreaticobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| |
Collapse
|
34
|
Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair. J Gastrointest Surg 2019; 23:618-625. [PMID: 30465190 DOI: 10.1007/s11605-018-4047-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Over the last 3 decades, laparoscopic procedures have emerged as the standard treatment for many elective and emergency surgical conditions. Despite the increased use of laparoscopic surgery, the role of laparoscopic repair for perforated peptic ulcer remains controversial among general surgeons. The aim of this study was to compare the outcomes of laparoscopic versus open repair for perforated peptic ulcer. METHODS A systemic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database of all randomised controlled trials (RCT) that compared laparoscopic (LR) with open repair (OR) for perforated peptic ulcer (PPU). Data was extracted using a standardised form and subsequently analysed. RESULTS The meta-analysis using data from 7 RCT showed that LR for PPU has decreased overall post-operative morbidity (LR = 8.9% vs. OR = 17.0%) (OR = 0.54, 95% CI 0.37 to 0.79, p < 0.01), wound infections, (LR = 2.2% vs. OR = 6.3%) (OR = 0.3, 95% CI 0.16 to 0.5, p < 0.01) and shorter duration of hospital stay (6.6 days vs. 8.2 days, p = 0.01). There were no significant differences in length of operation, leakage rate, incidence of intra-abdominal abscess, post-operative sepsis, respiratory complications, re-operation rate or mortality. There was no publication bias and the quality of the studies ranged from poor to good. CONCLUSION These results demonstrate that laparoscopic repair for perforated peptic ulcer has a reduced morbidity and total hospital stay compared with open approach. There are no significant differences in mortality, post-operative sepsis, abscess and re-operation rates. LR should be the preferred treatment option for patients with perforated peptic ulcer disease.
Collapse
|
35
|
Laparoscopic and open repair for perforated duodenal ulcer: single-center experience. Wideochir Inne Tech Maloinwazyjne 2019; 14:60-69. [PMID: 30766630 PMCID: PMC6372872 DOI: 10.5114/wiitm.2018.76281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/24/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Perforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery. Aim To analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer. Material and methods The study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group. Results In 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3–14), in the open group 11.7 days (range: 6–63), and in the conversion group 9.3 days (8–10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014–2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010–2013). Conclusions The laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20–25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.
Collapse
|
36
|
Vakayil V, Bauman B, Joppru K, Mallick R, Tignanelli C, Connett J, Ikramuddin S, Harmon JV. Surgical repair of perforated peptic ulcers: laparoscopic versus open approach. Surg Endosc 2019; 33:281-292. [PMID: 30043169 DOI: 10.1007/s00464-018-6366-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/20/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Perforated peptic ulcers are a surgical emergency that can be repaired using either laparoscopic surgery (LS) or open surgery (OS). No consensus has been reached on the comparative outcomes and safety of each approach. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, we conducted a 12-year retrospective review (2005-2016) and identified 6260 adult patients who underwent either LS (n = 616) or OS (n = 5644) to repair perforated peptic ulcers. To mitigate selection bias and adjust for the inherent heterogeneity between groups, we used propensity-score matching with a case (LS):control (OS) ratio of 1:3. We then compared intraoperative outcomes such as operative time, and 30-day postoperative outcomes including infectious and non-infectious complications, and mortality. RESULTS Propensity-score matching created a total of 2462 matched pairs (616 in the LS group, 1846 in the OS group). Univariate analysis demonstrated successful matching of patient characteristics and baseline clinical variables. We found that OS was associated with a shorter operative time (67.0 ± 28.6 min, OS versus 86.9 ± 57.5 min, LS; P < 0.001) but a longer hospital stay (8.6 ± 6.2 days, OS versus 7.8 ± 5.9 days, LS; P = 0.001). LS was associated with a lower rate of superficial surgical site infections (1.5%, LS versus 4.2%, OS; P = 0.032), wound dehiscence (0.3%, LS versus 1.6%, OS; P = 0.030), and mortality (3.2%, LS versus 5.4%, OS; P = 0.009). CONCLUSION Fewer than 10% of patients with perforated peptic ulcers underwent LS, which was associated with reduced length of stay, lower rate of superficial surgical site infections, wound dehiscence, and mortality. Given our results, a greater emphasis should be provided to a minimally invasive approach for the surgical repair of perforated peptic ulcers.
Collapse
Affiliation(s)
- Victor Vakayil
- Department of Surgery, University of Minnesota, Minneapolis, USA. .,School of Public Health, University of Minnesota, Minneapolis, USA. .,Critical Care and Acute Care Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - Brent Bauman
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Keaton Joppru
- University of Minnesota Medical School, Minneapolis, USA
| | - Reema Mallick
- Department of Surgery, University of Alabama-Birmingham, Birmingham, USA
| | | | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | | | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, USA
| |
Collapse
|
37
|
Jamal MH, Karam A, Alsharqawi N, Buhamra A, AlBader I, Al-Abbad J, Dashti M, Abulhasan YB, Almahmeed H, AlSabah S. Laparoscopy in Acute Care Surgery: Repair of Perforated Duodenal Ulcer. Med Princ Pract 2019; 28:442-448. [PMID: 30995637 PMCID: PMC6771047 DOI: 10.1159/000500107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The use of laparoscopic management as a first choice for the treatment of duodenal perforation is gaining ground but is not routine in many centers. In this report, we aim to report our experience with laparoscopy as the first approach for the repair of duodenal perforation. MATERIALS AND METHODS This is a retrospective review of patients during our initial experience with the use of laparoscopy for the treatment of duodenal perforation between 2009 and 2013. RESULTS A total of 100 patients underwent management of duodenal perforation. Laparoscopy was attempted initially in 76 patients (76%) and completed in 64 patients (64%). The length of hospital stay was shorter in the laparoscopic group (mean 2.6) than in the open group (mean 3.1) (p = 0.008). Complications developed in 14 patients (20%). There was a tendency towards fewer admissions to intensive care, less acute kidney injuries, and less acute respiratory distress syndrome in the laparoscopic group. In patients who underwent laparoscopic surgery, the chances of uneventful recovery were 4.3 times higher than in those patients who underwent open surgery (95% CI 1.3-13.5, p = 0.014). CONCLUSIONS Laparoscopy in the treatment of perforated duodenal ulcer is safe and can be utilized as a routine approach for the treatment of this pathology.
Collapse
Affiliation(s)
| | - Abdulazeez Karam
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Nourah Alsharqawi
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Abdulla Buhamra
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Ibtesam AlBader
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Jasem Al-Abbad
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Mohammad Dashti
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | | | - Husain Almahmeed
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Salman AlSabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
38
|
Singh RR, Nussbaum JS, Kumta NA. Endoscopic management of perforations, leaks and fistulas. Transl Gastroenterol Hepatol 2018; 3:85. [PMID: 30505972 DOI: 10.21037/tgh.2018.10.09] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022] Open
Abstract
The endoscopic management armamentarium of gastrointestinal disruptions including perforations, leaks, and fistulas has slowly but steadily broadened in recent years. Previously limited to surgical or conservative medical management, innovations in advanced endoscopic techniques like natural orifice transluminal endoscopic surgery (NOTES) have paved the path towards development of endoscopic closure techniques. Early recognition of a gastrointestinal defect is the most important independent variable in determining successful endoscopic closure and patient outcome. Some devices including through the scope clips and stents have been well studied for other indications and have produced encouraging results in closure of gastrointestinal perforations, leaks and fistulas. Over the scope clips, endoscopic sutures, vacuum therapy, glue, and cardiac device occluders are other alternative techniques that can be employed for successful endoscopic closure.
Collapse
Affiliation(s)
- Ritu Raj Singh
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremy S Nussbaum
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
39
|
|
40
|
Mirabella A, Fiorentini T, Tutino R, Falco N, Fontana T, De Marco P, Gulotta E, Gulotta L, Licari L, Salamone G, Melfa I, Scerrino G, Lupo M, Speciale A, Cocorullo G. Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study. BMC Surg 2018; 18:78. [PMID: 30253756 PMCID: PMC6156951 DOI: 10.1186/s12893-018-0413-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient’s age, surgical technique and Boey’s score were evaluated. Results The relationship between laparoscopic or open treatment and the Boey’s score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients’ Boey’s score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey’s score group and in the 10.7% of the high Boey’s score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey’s score. In our series laparoscopy was not used in high risk Boey’s score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.
Collapse
Affiliation(s)
- Antonino Mirabella
- O.U. of Emergency and General Surgery of "Villa Sofia" Hospital, Palermo, Italy
| | - Tiziana Fiorentini
- O.U. of Emergency and General Surgery of "Cervello" Hospital, Palermo, Italy
| | - Roberta Tutino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | - Nicolò Falco
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Tommaso Fontana
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Paolino De Marco
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Eliana Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Leonardo Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Leo Licari
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Irene Melfa
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Massimo Lupo
- O.U. of Emergency and General Surgery of "Villa Sofia" Hospital, Palermo, Italy
| | - Armando Speciale
- O.U. of Emergency and General Surgery of "Cervello" Hospital, Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| |
Collapse
|
41
|
Leusink A, Markar SR, Wiggins T, Mackenzie H, Faiz O, Hanna GB. Laparoscopic surgery for perforated peptic ulcer: an English national population-based cohort study. Surg Endosc 2018; 32:3783-3788. [DOI: 10.1007/s00464-018-6058-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
|
42
|
Davenport DL, Ueland WR, Kumar S, Plymale M, Bernard AC, Roth JS. A comparison of short-term outcomes between laparoscopic and open emergent repair of perforated peptic ulcers. Surg Endosc 2018; 33:764-772. [DOI: 10.1007/s00464-018-6341-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
|
43
|
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.
Collapse
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.
| |
Collapse
|
44
|
Abstract
Helicobactor pylori infection has been associated with peptic ulcer disease and is currently treated with proton pump inhibitors (PPIs), which have reduced the complications of the disease. Perforation of either a gastric or duodenal ulcer is rarely treated with surgery. We report the case of double-perforated synchronous duodenal ulcers, which is an extremely infrequent condition. To our knowledge, no English case reports have yet been published. Therefore, awareness of the physician in the field of diagnosis and treatment of this peptic ulcer is required. We report the case of a 46-year-old male patient who presented with acute abdominal pain at the emergency surgical department of our hospital. According to patient history, smoking, alcohol consumption, and frequent postprandial abdominal pain were noted. A physical examination revealed a rigid abdomen and tachycardia, and the temperature was 37.8°C. Laboratory testing showed increased levels of leukocytes, and free subdiaphragmatic air was found in the chest X-ray. Due to rapid deterioration of his clinical condition, the patient underwent urgent surgery. An explorative laparotomy showed 2 perforated kissing ulcers at the first segment of the duodenum, in the anterior and posterior walls. A peripheral gastrectomy was performed. Postoperative follow-up did not result in any complications. In regard to this case we present, simultaneous perforation of two synchronous duodenal ulcers is an uncommon but possible incident of which the clinician should be aware. To our knowledge, this is the first case published in the literature.
Collapse
|
45
|
Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique. Asian J Surg 2018; 41:136-142. [DOI: 10.1016/j.asjsur.2016.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022] Open
|
46
|
Kim TH, Park JH, Jeong SH, Lee JK, Kwag SJ, Kim JY, Lee W, Woo JW, Jang JY, Song EJ, Park T, Jeong CY, Ju YT, Jung EJ, Hong SC, Choi SK, Ha WS, Lee YJ. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc 2018; 32:3667-3674. [PMID: 29470633 DOI: 10.1007/s00464-018-6099-y] [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: 09/11/2017] [Accepted: 02/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic primary repair is one of the main procedures used for perforated gastric ulcers, and this technique requires reproducible and secure suturing. The aim of this study was to investigate the safety and efficacy of a novel continuous suture method with barbed sutures during laparoscopic repair for perforated peptic ulcers. PATIENTS AND METHODS Clinical data from 116 consecutive patients undergoing laparoscopic repair for perforated peptic ulcers were collected between November 2009 and October 2015. Continuous suturing with 15-cm-long unidirectional absorbable barbed sutures was used for laparoscopic repair in the study group, termed group V (n = 51). Patients who underwent laparoscopic repair with conventional interrupted sutures were defined as group C (n = 65). The complication and operative data were compared between groups. RESULTS Although there was no difference between group V and group C in the overall complication rate (15.7% vs. 24.6%; p = 0.259), the complication rate related to suturing was lower (3.9% vs. 15.4%; p = 0.04) in group V. Group V showed rates of 0% for leakage, 2% for intra-abdominal fluid collection, and 2% for stricture; the corresponding rates in group C were 3.1, 7.7, and 4.6%, respectively. Regarding operative data, the total operation time (V vs. C, 87.7 min vs. 131.2 min), total suture time (7.1 min vs. 25.3 min), and suture time per stitch (1.2 min vs. 6.2 min) were significantly shorter in group V than in group C (p < 0.001). CONCLUSION The use of a continuous suture technique with unidirectional barbed sutures is as safe as the conventional suture technique and allows easier and faster suturing in the repair of perforated peptic ulcers.
Collapse
Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Eun-Jin Song
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Sang-Kyung Choi
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Woo-Song Ha
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
| |
Collapse
|
47
|
Vărcuş F, Beuran M, Lica I, Turculet C, Cotarlet AV, Georgescu S, Vintila D, Sabău D, Sabau A, Ciuce C, Bintintan V, Georgescu E, Popescu R, Tarta C, Surlin V. Laparoscopic Repair for Perforated Peptic Ulcer: A Retrospective Study. World J Surg 2017; 41:948-953. [PMID: 27882415 DOI: 10.1007/s00268-016-3821-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUNDS The incidence of patients presenting with perforated peptic ulcers (PPU) has decreased during the last decades. At the same time, a laparoscopic approach to this condition has been adopted by increased number of surgeons. The aim of this study was to evaluate the early postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in eight Romanian surgical centers with extensive experience in laparoscopic surgery. METHODS Between 2009 and 2013, 297 patients with perforated peptic ulcer were operated in the eight centers participating in this retrospective study. The patients' charts were reviewed for demographics, surgical procedure, complications and short-term outcomes. RESULTS Boey score of 0 was found in 122 patients (41.1%), Boey 1 in 169 (56.9%), Boey 3 in 6 (2.0%). For 145 (48.8%) patients, primary suture repair was performed, in 146 (49.2%) primary suture repair with omentopexy. There were 6 (2.0%) conversions to open surgery. The operative time was between 25 and 120 min, with a mean of 68 min. Two (0.7%) deaths were noted. Mean hospital stay was 5.5 days, ranges 3-25 days. Postoperative complications included: 7 (2.4%) superficial surgical site infections, 5 (1.6%) cardiovascular, 3 (1.0%) pulmonary, 2 (0.7%) duodenal leakages, 3 (1.0%) deep space infections and 1 (0.3%) upper digestive hemorrhage. CONCLUSIONS This study shows that the laparoscopic approach for PPU is feasible; the procedure is safe, with no increased risk of duodenal fistulae or residual intraperitoneal abscesses. We now consider the laparoscopic approach for PPU as the "gold standard" in patients with Boey score 0 or 1.
Collapse
Affiliation(s)
- Flore Vărcuş
- Surgical Clinic 2, Clinical Emergency County Hospital, Victor Babes University of Medicine and Pharmacy, Str. I. Bulbuca, No. 10, Timisoara, Romania.
| | - Mircea Beuran
- Surgical Clinic 2, Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Lica
- Surgical Clinic 2, Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Claudiu Turculet
- Surgical Clinic 2, Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Stefan Georgescu
- Surgical Clinic 2, County Emergency Hospital "Sf. Spiridon", Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Dan Vintila
- Surgical Clinic 2, County Emergency Hospital "Sf. Spiridon", Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Dan Sabău
- Surgical Clinic 2, Emergency County Hospital, Victor Papilian Faculty of Medicine, Sibiu, Romania
| | - Alexandru Sabau
- Surgical Clinic 2, Victor Papilian Faculty of Medicine, Sibiu, Romania
| | - Constantin Ciuce
- Surgical Clinic 1, Emergency County Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vasile Bintintan
- Surgical Clinic 1, Emergency County Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Eugen Georgescu
- Surgical Clinic 1, County Emergency Hospital, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Razvan Popescu
- Surgical Clinic 2, Emergency County Hospital, Faculty of Medicine, Ovidius University, Constanţa, Romania
| | - Cristi Tarta
- Surgical Clinic 2, Clinical Emergency County Hospital, Victor Babes University of Medicine and Pharmacy, Str. I. Bulbuca, No. 10, Timisoara, Romania
| | - Valeriu Surlin
- Surgical Clinic 1, County Emergency Hospital, University of Medicine and Pharmacy Craiova, Craiova, Romania
| |
Collapse
|
48
|
Laparoscopic pyloroplasty for perforated peptic ulcer. Wideochir Inne Tech Maloinwazyjne 2017; 12:311-314. [PMID: 29062455 PMCID: PMC5649495 DOI: 10.5114/wiitm.2017.68537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/21/2017] [Indexed: 11/17/2022] Open
Abstract
Peptic ulcer is a common disease affecting millions of people every year. Despite improved understanding and treatment of the disease, the number of patients admitted with duodenal peptic ulcer perforation has not decreased. Deaths from peptic ulcer disease overcome other common emergency situations. Laparoscopic repair of the perforated peptic ulcer (PPU) is the gold standard approach for simple perforation. However, in patients with large perforated chronic ulcers laparotomy with pyloroplasty is the standard treatment. It is generally accepted to perform open surgery in PPU emergencies because of the greater knowledge and experience gathered over the past decades and less potential harm for the patient or surgical complications. We present a case of successful laparoscopic pyloroplasty of a perforated duodenal ulcer with stenosis.
Collapse
|
49
|
Siletz A, Grotts J, Lewis C, Tillou A, Cryer HM, Cheaito A. Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery. Am Surg 2017. [DOI: 10.1177/000313481708301015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this study was to evaluate usage and outcomes of emergency laparoscopic versus open surgery at a single tertiary academic center. Over a three-year period 165 patients were identified retrospectively using National Surgical Quality Improvement Program results. Appendectomies and cholecystectomies were excluded. Open and laparoscopic approaches were compared regarding preoperative and operative characteristics, the development of postoperative complications, 30-day mortality, and length of hospital stay. Indications for operation were similar between groups. Patients who underwent open surgery had more severe comorbidities and higher ASA class. Laparoscopy was associated with reduced complication rates, operative time, length of stay, and discharges to skilled nursing facilities on univariate analysis. In a multivariate model, surgical approach was not associated with the development of complications. Older age, dependent status, and dyspnea were predictors of conversion from attempted laparoscopic to open approaches.
Collapse
Affiliation(s)
| | - Jonathan Grotts
- UCLA Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | - Ali Cheaito
- Department of Surgery, Los Angeles, California
| |
Collapse
|
50
|
Laparoscopic and Open Surgical Treatment in Gastroduodenal Perforations: Our Experience. Surg Laparosc Endosc Percutan Tech 2017; 27:113-115. [PMID: 28207574 PMCID: PMC5377998 DOI: 10.1097/sle.0000000000000376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Peptic ulcer perforation (PPU) is a common surgical emergency and the mortality rate ranges 10% to 40%, especially in elderly patients. Laparoscopic repair achieved encouraging results. MATERIALS AND METHODS We enrolled patients performing surgical repair for PPU from January 2007 to December 2015 in our surgical unit. The aim of this retrospective observational study was to compare the results of PPU laparoscopic repair with open technique. The following characteristics of patients were evaluated: age, sex and American Society of Anesthesiologists classification. The site and the diameter of perforation were recorded: gastric, pyloric, duodenal, and the location on the anterior or posterior wall. RESULTS In total, 59 patients (39 males and 20 females) with a mean age of 58.85 years (±SD) were treated surgically. Laparoscopic repair was accomplished in 21 patients. The mean operative time for laparoscopic repair was 72 minutes (±SD), significantly shorter than open repair time (180 min ±SD). The results demonstrated that laparoscopic repair is associated with a shorter operative time, reduced postoperative pain (4.75 vs. 6.42) and analgesic requirements, a shorter hospital stay (7.5 vs. 13.1), and earlier return to normal daily activities. DISCUSSION Laparoscopic surgery minimizes postoperative wound pain and encourages early mobilization and return to normal daily activities. The benefit of early discharge and return to work may outweigh the consumable cost incurred in the execution of laparoscopic procedures. CONCLUSIONS Complications in both procedures are similar but laparoscopic procedure shows economic advantages for reducing postoperative hospital stay, postoperative pain, and for a good integrity of abdominal wall.
Collapse
|