A comparison of short-term outcomes between laparoscopic and open emergent repair of perforated peptic ulcers

Dl, Davenport; Wr, Ueland; Kumar, Sameera; Plymale, Margaret A.; Ac, Bernard; Js, Roth

doi:10.1007/s00464-018-6341-7

Cited by 16 publications

(14 citation statements)

References 24 publications

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“…Although multiple studies have demonstrated the benefits of repairing PPUs laparoscopically, in our study, it was associated with longer operative duration (Laparoscopic 117.1 ± 35.6 min, open 85.6 ± 41.8 min, p = 0.01), which is comparable to other studies [ 17 , 20 ]. This may be explained by the fact that there is improved exposure and more efficient mobilization in open repair.…”

Section: Discussionsupporting

confidence: 83%

“…These outcomes directly lead to decreased cost and increased patient satisfaction. The study by Davenport and colleagues [ 17 ] demonstrated that within the United States American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) population, the proportion of laparoscopic PPU repairs has nearly tripled from 4.5% in 2010 to 11.4% in 2016 ( p < 0.001), indicating that more surgeons are utilizing the laparoscopic approach to repair PPUs. This can be attributed to generally decreased morbidity associated with laparoscopic surgery and increased study data pertaining to safety and efficacy of the technique, with improved postoperative outcomes including reduced surgical site infections, postoperative complications, and hospital length of stay [ 1 , 11 , 12 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study by Davenport and colleagues [ 17 ] demonstrated that within the United States American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) population, the proportion of laparoscopic PPU repairs has nearly tripled from 4.5% in 2010 to 11.4% in 2016 ( p < 0.001), indicating that more surgeons are utilizing the laparoscopic approach to repair PPUs. This can be attributed to generally decreased morbidity associated with laparoscopic surgery and increased study data pertaining to safety and efficacy of the technique, with improved postoperative outcomes including reduced surgical site infections, postoperative complications, and hospital length of stay [ 1 , 11 , 12 , 17 , 18 ]. Additionally, in a large meta-analysis of five randomized controlled trials examining laparoscopic versus open repair of PPU, Tan and colleagues [ 19 ] demonstrated that laparoscopic outcomes were comparable to open surgery with regard to re-operation and mortality, while laparoscopic repair was associated with significant reduction in surgical site infection, faster time to diet and less postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

et al. 2022

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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. Graphical abstract

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

et al. 2022

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“…Included studies were published between 1996 and 2019. Five were RCTs [14][15][16][17][18] , three were prospective cohort studies [19][20][21] , and the other 15 studies used retrospective cohort or case-control designs [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] ( Table 1). All compared outcomes of laparoscopic versus open peptic ulcer repair.…”

Section: Resultsmentioning

confidence: 99%

Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review

Lee

Coe

O'Donoghue³

et al. 2020

British Journal of Surgery

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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.

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“…The finding of surgical intervention for perforated ulcers is viewed as the mainstay of care, as noted by Lee et al 14 Specifically, the use of a laparoscopic approach with an experienced surgeon in stable patients is supported by a meta-analysis performed by Cirocchi et al 15 that found the laparoscopic approach to primarily reduce postoperative pain in the first 24 hours, and reduce postoperative wound infection compared to an open approach for perforated peptic ulcer repair. Similarly, a retrospective review by Davenport et al 16 reports reduced length of stay, decreased mortality and renal insufficiency, and improved respiratory function for patients without preoperative shock who were treated for perforated peptic ulcer using the laparoscopic approach compared to an open approach.…”

Section: Delay In Interventionmentioning

confidence: 95%

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

Lin

Smiley

Goud

et al. 2022

The American Surgeon

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Background We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs). Methods A National Inpatient Sample–based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality. Results 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well. Conclusion Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.

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A comparison of short-term outcomes between laparoscopic and open emergent repair of perforated peptic ulcers

Abstract: Emergent laparoscopic repair of perforated peptic ulcer is increasingly being performed, is safe relative to open repair (in patients without preoperative septic shock), and confers a modest benefit in terms of length of stay, respiratory, and abdominal wall wound complications.

Cited by 16 publications

References 24 publications

Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

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