Laparoscopic Repair Modality of Perforated Peptic Ulcer: Less Is More?

Abstract

Perforation, per se, presents the most serious complication of peptic ulcer disease with a mortality rate that cannot be underestimated. Surgery is the only treatment option, which can be performed laparoscopically or via conventional laparotomy. The present study aimed to compare the short-term outcomes of laparoscopy and laparotomy techniques in the surgical treatment of peptic ulcer perforation. A retrospective study design was structured to compare the perioperative and short-term postoperative outcomes of 102 patients who had undergone laparoscopic and conventional repair of the perforated peptic ulcer over a six-year interval (January 1, 2016, to December 31, 2021). Of these, 44 (43.1%) had undergone laparoscopic repair while 58 (56.9%) had surgical repair via conventional laparotomy. The operative time and length of hospital stay were comparable in both subgroups (p=0.984 and p =0.585). Nevertheless, 30-day postoperative morbidity was significantly higher in the open surgery subgroup (75.9% vs. 59.1%, p= 0.032). The risk of relaparotomy was similar in both study subgroups; however, suture dehiscence as a reason for surgical revision was significantly more frequent in the laparoscopic subgroup (13.6% vs 3.4%). Of note, the mortality rate in the laparoscopic group of patients was 13.6%, and in the laparotomy group 41.4%. The laparoscopic approach to peptic ulcer perforation is the procedure of choice for low-risk patients. Conventional surgery seems to be associated with a significantly higher incidence of severe postoperative complications and mortality. However, the higher mortality in these patients is probably related to their worse initial clinical condition.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial

“…In the present study, we investigated the effect of an intraoperative warming heating blanket with forced air warming on postoperative pain and analgesic consumption in short and long laparoscopic surgical procedures. In the United Kingdom, the National Institute for Health and Care Excellence recommends the following: (i) monitoring patients' intraoperative temperature every 30 minutes; (ii) delaying anesthesia induction until the patient's body temperature rises above 36°C; (iii) warming intravenous fluids and blood products to 37°C; (iv) using a forced-air warming device placed over patients for heating purposes for procedures lasting longer than 30 minutes; and (v) if normothermia can be maintained through warmed irrigation or external warming devices, it can be concluded that there is no need for warmed insufflation systems and the additional costs they bring [ 3 , 4 , 7 ]. Herein, we planned this work with the hypothesis that hypothermia could be prevented through a patient warming procedure rather than warming and humidifying CO2 gas.…”

“…Briefly, heat loss depends on the wound site, which can be more significant compared to laparoscopy in conventional surgical procedures. However, alterations in temperature due to carbon dioxide (CO2) insufflation during laparoscopic surgeries appear [2][3][4][5][6]. In addition, warming and humidification of insufflated CO2 gas have been reported in order to reduce the development of hypothermia [7][8][9][10][11].…”

Laparoscopia versus laparotomia na Úlcera Péptica Perfurada: revisão de literatura dos últimos cinco anos

“…Como explanado anteriormente, a cirurgia laparoscópica vem sendo correlacionada a diminuição de ocorrência de intercorrências, como pneumonia e eventos cardíacos isquêmicos Outras complicações presentes no grupo de laparotomia são deiscência da ferida (VAKAYIL et al, 2019), mais internações em terapia intensiva, mais número de lesões renais agudas e maior síndrome do desconforto respiratório agudo (JAMAL et al, 2019), taxas altas de ventilação/reintubação prolongada (DAVENPORT et al, 2018), infecção torácica (SENGUPTA et al, 2020), maior risco de sangramento (14,6% versus 8%) e pneumonia (8,7% versus 4,5%) (JAYARAMAN et al, 2021). Acerca de operações laparoscópicas minimamente invasivas, em comparação com laparotomia possuem menor ocorrência de complicações, porém a falha na sutura acontece de forma similar (PANIN et al, 2021) ou até mesmo com maior frequência, pela deiscência da sutura (TULINSKÝ et al, 2022). Há explanações quanto a ocorrência de pneumotórax pela técnica laparoscópica de omentopexia com oito suturas (YOON et al, 2019).…”

“…Também há relatos de um tempo semelhante entre a laparoscopia e laparotomia propriamente ditas (TULINSKÝ et al, 2022;AKIN et al, 2022).Outro fator importante está relacionado aos ambientes de saúdes com recursos limitados, o tempo de internação continua favorável para técnicas laparoscópicas, com média até menores do que os encontrados em outros centros, sendo de 5,10 ± 0,87 dias (AYYAZ et al, 2022).…”

“…A laparotomia apresenta maior taxas de mortalidade pós-operatórias em comparação a cirurgias laparoscópicas minimamente invasivas (VARCUS et al, 2018;PANIN et al, 2021), sendo digno de nota a taxa de mortalidade em pacientes laparoscópicos, com 13,6%, contrapondo com o grupo de laparotomia, com 41,4% (TULINSKÝ et al, 2022). Ahmed et al (2022) propuseram avaliar os fatores de risco que influenciam o resultado pós-operatório em pacientes com úlcera péptica perfurada, encontrando maiores índices de mortalidade em pacientes com a idade avançada (≥ 60 anos), choque pré-operatório, presença de comorbidades e creatinina sérica elevada.…”