Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study

Saleh, Adel Alhaj; Esquivel, Esteban; Lung, John; Eaton, Barbara; Bruns, Brandon R.; Barmparas, Galinos; Margulies, Daniel R.; Raines, Alexander; Bryant, Cressilee; Crane, Christopher E.; Scherer, Elizabeth P.; Schroeppel, Thomas J.; Moskowitz, Eliza E.; Regner, Justin L.; Frazee, Richard C.; Campion, Eric M.; Bartley, Matthew G.; Mortus, Jared; Ward, Jeremy L.; Almekdash, Mhd Hasan

doi:10.1016/j.amjsurg.2019.09.002

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…For decades, laparoscopic surgery has gradually proven its safety and feasibility to treat PPU [ 11 , 22 ]. In selected patients, laparoscopic simple closure with or without omental coverage has become the procedure of choice [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In selected patients, laparoscopic simple closure with or without omental coverage has become the procedure of choice [ 23 ]. Compared to those who underwent conventional laparotomy, patients who underwent laparoscopic repair had significant advantages, including less postoperative pain, lower overall complication rates, fewer wound infections and dehiscence, shorter lengths of hospital stay, and earlier return to normal life [ 8 , 9 , 11 , 13 ]. In the 2020 WSES guidelines, the laparoscopic approach is suggested to be the first-line treatment for stable patients with small ulcers as long as surgeons are familiar with the skill and appropriate equipment is available [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown to be a safe and feasible procedure with less postoperative pain and less wound infection than laparotomy [7][8][9][10]. Hence, some studies have suggested a "laparoscopy-first" approach for PPU to maximize the advantages of laparoscopic surgery [11,12]. However, conversion to laparotomy following a laparoscopic attempt is not uncommon, and recent data show that the conversion rate is between 7.9% and 44% [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Potential use of peptic ulcer perforation (PULP) score as a conversion index of laparoscopic-perforated peptic ulcer (PPU) repair

Wang

et al. 2020

Eur J Trauma Emerg Surg

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Background Laparoscopic repair is a well-accepted treatment modality for perforated peptic ulcer (PPU). However, intraoperative conversion to laparotomy is still not uncommon. We aimed to identify preoperative factors strongly associated with conversion. Methods A retrospective review of records of all PPU patients treated between January 2011 and July 2019 was performed. Patients were divided into three groups: laparoscopic repair (LR), conversion to laparotomy (CL), and primary laparotomy (PL). Patient demographics, operative findings, and outcomes were compared between the groups. Logistic regression analyses were performed, taking conversion as the outcome. Results Of 822 patients, there were 236, 45, and 541 in the LR, CL, and PL groups, respectively. The conversion rate was 16%. Compared with those in the LR group, patients in the CL group were older (p < 0.001), had higher PULP scores (p < 0.001), had higher ASA scores (p < 0.001) and had hypertension (p = 0.003). PULP score was the only independent risk factor for conversion. The area under the curve (AUC) for the PULP score to predict conversion was 75.3%, with a best cut-off value of ≥ 4. The operative time was shorter for PL group patients than for CL group patients with PULP scores ≥ 4. For patients with PULP scores < 4, LR group patients had a shorter length of stay than PL group patients. Conclusion The PULP score may have utility in predicting and minimizing conversion for laparoscopic PPU repair. Laparoscopic repair is the procedure of choice for PPU patients with PULP scores < 4, while open surgery is recommended for those with PULP scores ≥ 4.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Potential use of peptic ulcer perforation (PULP) score as a conversion index of laparoscopic-perforated peptic ulcer (PPU) repair

Wang

et al. 2020

Eur J Trauma Emerg Surg

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“…Demographics and clinical data were collected using a standardized data collection sheet as previously described. 11 …”

Section: Methodsmentioning

confidence: 99%

“…Demographics and clinical data were collected using a standardized data collection sheet as previously described. 11 For this study, additional data points were reviewed, including use of AF therapy (fluconazole, micafungin or other) with the time interval from the index surgery to the first dose, blood cultures obtained in the perioperative period (preoperative and up to 48 hours postoperatively), intraperitoneal (IP) cultures obtained at the index surgery with microbiology results, and development of OSI, defined as an event occurring within 30 days after the operative procedure (where day 1=the procedure date) and involving any part of the abdomen deeper than the fascial/muscle layers that was opened or manipulated during the operative procedure and the patient had at least one of the following: (A) purulent drainage from a drain that is placed into the abdomen; (B) organism(s) identified from fluid or tissue in the abdomen by a culture or non-culture-based microbiological testing method which was performed for purposes of clinical diagnosis or treatment; (C) an abscess or other evidence of infection involving the abdomen that was detected on gross anatomic or histopathological examination, or imaging test evidence suggestive of infection. 12…”

Section: Introductionmentioning

confidence: 99%

Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer

Barmparas

Saleh

Huang

et al. 2021

Trauma Surg Acute Care Open

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IntroductionInfection control in patients with perforated peptic ulcers (PPU) commonly includes empiric antifungals (AF). We investigated the variation in the use of empiric AF and explored the association between their use and the subsequent development of organ space infection (OSI).MethodsThis was a secondary analysis of a multicenter, case–control study of patients treated for PPU at nine institutions between 2011 and 2018. Microbiology and utilization of empiric AF, defined as AF administered within 24 hours from the index surgery, were recorded. Patients who received empiric AF were compared with those who did not. The primary outcome was OSI and secondary outcome was OSI with growth of Candida spp. A logistic regression was used to adjust for differences between the two cohorts.ResultsA total of 554 patients underwent a surgical procedure for PPU and had available timing of AF administration. The median age was 57 years and 61% were male. Laparoscopy was used in 24% and omental patch was the most common procedure performed (78%). Overall, 239 (43%) received empiric AF. There was a large variation in the use of empiric AF among participating centers, ranging from 25% to 68%. The overall incidence of OSI was 14% (77/554) and was similar for patients who did or did not receive empiric AF. The adjusted OR for development of OSI for patients who received empiric AF was 1.04 (95% CI 0.64 to 1.70), adjusted p=0.86. The overall incidence of OSI with growth of Candida spp was 5% and was similar for both groups (adjusted OR 1.29, 95% CI 0.59 to 2.84, adjusted p=0.53).ConclusionFor patients undergoing surgery for PPU, the use of empiric AF did not yield any significant clinical advantage in preventing OSI, even those due to Candida spp. Use of empiric AF in this setting is unnecessary.Study typeOriginal article, case series.Level of evidenceIII.

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Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study

Abouelazayem,

Jain,

Wilson

et al. 2024

Surg Endosc

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Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study

Cited by 14 publications

References 16 publications

Potential use of peptic ulcer perforation (PULP) score as a conversion index of laparoscopic-perforated peptic ulcer (PPU) repair

Potential use of peptic ulcer perforation (PULP) score as a conversion index of laparoscopic-perforated peptic ulcer (PPU) repair

Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study

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