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

Abstract

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

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture

“…In the 1960s, the predominant procedure ranged from vagotomy and pyloroplasty to partial gastrectomy, associated with inherent risks [ 38 , 39 , 40 ]. However, in the subsequent decades, a less aggressive approach recommending simple suture with or without omentoplasty, omental pedicle flap (Cellan-Jones repair), free omental plug (Graham patch), or jejunal serosa patch gained traction together with a laparoscopic approach [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Modifications in surgical techniques, such as the use of fibrin glue, automated stapler devices, and continuous suture closure, have evolved to streamline the procedure and reduce operative complexity.…”

Experience of management of pediatric upper gastrointestinal perforations: a series of 30 cases

“…Conservative treatment is confirmed as safe and feasible for some selected cases of perforated peptic duodenal ulcers, including the duration of symptom onset being within 24 h of admission with a stable condition, localized peritoneal irritation signs, and mild ascites (15,34,35). A gastroduodenogram is usually needed to evaluate water-soluble contrast extravasation.…”

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

“…A omentopexia consiste na sutura contínua com fio absorvível sem nós farpado (KIM; SANGHYUN; JEE,2021). O reparo de Cellan-Jones modificado por laparoscopia ocasiona em menor perda de sangue estimada, Brazilian Journal of Health Review, Curitiba, v. 6, n. 1, p. 3242-3264, jan./feb., 2023 remoção antecipada da sonda nasogástrica, retomada precoce da dieta, menor uso de medicamentos e retorno mais antecipado da função intestinal, em comparação a laparotomia (ODISHO et al, 2022).…”

“…No que se refere ao tempo operatório, quando realizada laparoscopia com e sem correção omental, foi menor no grupo sem correção (MOHAMEDAHMED et al, 2022). Esse achado valida um estudo de Pan et al (2020), com pacientes submetidos a fechamento simples sem correção omental (grupo A) e fechamento simples com correção omental (grupo B), com tempo de operação médio de 84,4 minutos para o grupo A e 106,65 minutos no grupo B. Um maior tempo operatório também foi observado em casos de reparo de Cellan-Jones modificado por laparoscopia, comparados a laparoscopia (ODISHO et al, 2022).…”