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Alhaj Saleh A, Esquivel EC, Lung JT, Eaton BC, Bruns BR, Barmparas G, Margulies DR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner J, Frazee R, Campion EM, Bartley M, Mortus J, Ward J, Almekdash MH, Dissanaike S. Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study. Am J Surg 2019; 218:1060-1064. [PMID: 31537324 DOI: 10.1016/j.amjsurg.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
RCTs showed benefits in Lap repair of perforated peptic ulcer (PPU). The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice. Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included. 461 PATIENTS: Open in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0-67%). Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p < 0.05) as was unplanned re-operation (4.7% vs 14%, p < 0.05). Lap reduced LOS (6 vs 8 days, p < 0.001). Ileus was more in Lap (42% vs 18 p < 0.001) operative time was 14 min higher in Lap(p < 0.01) and admission to OR time was 4 h higher in Lap(<0.05). No significant difference readmission or mortality. Our results suggest Lap should be considered a first-line option in suitable PPU patients requiring omental patch repair in centers that have the capacity and resources 24/7.
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Affiliation(s)
- Adel Alhaj Saleh
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Esteban C Esquivel
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - John T Lung
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Barbara C Eaton
- Department of Surgery, University of Maryland Medical System, Baltimore, MD, USA
| | - Brandon R Bruns
- Department of Surgery, University of Maryland Medical System, Baltimore, MD, USA
| | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel R Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander Raines
- Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Cressilee Bryant
- Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Christopher E Crane
- Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Elizabeth P Scherer
- Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Thomas J Schroeppel
- Department of Surgery, UCHealth Memorial Hospital Center, Colorado Springs, CO, USA
| | - Eliza Moskowitz
- Department of Surgery, UCHealth Memorial Hospital Center, Colorado Springs, CO, USA
| | - Justin Regner
- Department of Surgery, Baylor Scott and White Health, Temple, TX, USA
| | - Richard Frazee
- Department of Surgery, Baylor Scott and White Health, Temple, TX, USA
| | - Eric M Campion
- Department of Surgery, Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Matthew Bartley
- Department of Surgery, Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Jared Mortus
- Department of Surgery, Baylor College of Medicine, Ben Taub, TX, USA
| | - Jeremy Ward
- Department of Surgery, Baylor College of Medicine, Ben Taub, TX, USA
| | - Mhd Hasan Almekdash
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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