Laparoscopic repair of perforated peptic ulcer

Varcus, Flore; Păun, I; Duţă, Ciprian; Dobrescu, Amadeus; Frandeș, Mirela; Tarţa, Cristi

doi:10.23736/s0026-4733.18.07603-4

Cited by 17 publications

(11 citation statements)

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“…This is linked with the advantages of laparoscopic surgery over open surgery such as reduced postoperative pain, lower wound infection rate, decreased length of hospital stay, and earlier functional recovery. 24,28,29,[37][38][39][40][41][42][43][44][45] Our study show a similar trend of laparoscopic versus open gastric repair during the study period: laparoscopic repair for PPU was performed in 49.2% of the cases, to other national and international series. 30,40,[44][45][46] Patient selection remains one of the most important factors impacting on the outcome of laparoscopic.…”

Section: Discussionsupporting

confidence: 60%

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

Fransvea

Costa

Lepre

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction:The number of elderly patients requiring emergency surgical intervention has increased dramatically. Perforated peptic ulcer (PPU) complications, such as perforation, have remained relatively stable and associated morbidity remains between 10% and 20%. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. The aim of this study was to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in the elderly using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study.Materials and Methods: This is a retrospective analysis carried out on data of the FRAILESEL study. Data on all the elderly patients who underwent emergency abdominal surgery for PPU from January 2017 to December 2017 at 36 Italian surgical departments were analyzed. Patients who underwent PPU repair were further divided into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastroduodenal repair (OGR) cohort, and the clinicopathologic features of the patients in both the groups were compared.Results: Sixty-seven patients fulfilled the inclusion criteria. Thirtythree patients (47.8%) underwent LGR. The LGR patients had less blood loss and shorter postoperative stay, even if the difference was not statistically significant. The mean operative time was significantively higher in the OGR (OGR 96.5 ± 27.7 vs. LGR 78.6 ± 16.3 P = 0.000). The rate of death after laparoscopic surgery was similar to the rate of the open surgery. Multivariate analysis indicated that only age (P = 0.018), admission haemoblogbin (Hb) level (P = 0.006), platelet count (P = 0.16), lactate level (P = 0.47), and Mannheim Peritonitis Index (P = 0.18) were independent variables associated with the risk of overall mortality. Conclusions:LGR is safe and feasible in elderly patients with PPU and it is associated with better perioperative outcomes. However, patient selection and preoperative frailty evaluation in the elderly population are the key to achieving better outcomes.

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Section: Discussionsupporting

confidence: 60%

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

Fransvea

Costa

Lepre

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Furthermore, in terms of the requirement for intraoperative transfusion and length of hospital stay, the outcomes of PULP score < 4 patients were significantly better if they were managed by the laparoscopic approach. These results were consistent with those of many reports in the literature [ 13 , 17 , 28 ], demonstrating the potential utility of the PULP score to assist in selecting an appropriate surgical procedure for patients.…”

Section: Discussionsupporting

confidence: 91%

“…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 – 16 ]. Most of the conversions were decided intraoperatively and were related to patient or tissue factors or technical limitations, such as hemodynamic instability, large ulcer, difficult ulcer location, or poor tissue condition [ 2 , 17 ]. Nonetheless, conversions might be associated with longer operation times, consuming additional medical resources that negatively impact hospital management flow.…”

Section: Introductionmentioning

confidence: 99%

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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“…The laparoscopic approach in the therapeutic management of PU perforation has been assessed in several studies [16,21]. LR has shown similar or better short-term results than open repair in terms of postoperative morbidity, mortality, operative time, and hospital stay; however, leakage can be significantly higher [22].…”

Section: Discussionmentioning

confidence: 99%

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

Tulinský¹,

Şengül²,

Şengül³

et al. 2022

Cureus

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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.

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Laparoscopic repair of perforated peptic ulcer

Cited by 17 publications

References 0 publications

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

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

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

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