A Comparison of Laparoscopic Versus Open Repair for the Surgical Treatment of Perforated Peptic Ulcers

Domínguez-Vega, Gerardo; Pera, Manuel; Ramón, José́; Puig, Sònia; Membrilla, Estela; Sancho, J. Sánchez de Toledo; Grande, Luis

doi:10.1016/j.cireng.2013.10.034

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…High age, delayed intervention, co-morbidity, smoking, and septic shock on arrival are all factors that increase both morbidity and mortality after a perforated duodenal ulcer, as reviewed by many authors [ 2 , 3 , 6 ]. The complication rate, Clavien-Dindo 2–4, in the current study was 12/28 patients (42%), which is consistent with reports in the literature [ 20 , 21 ]. Late intervention, more than 12 h after symptom onset, was associated with a Clavien-Dindo grade 3–4 complication.…”

Section: Discussionsupporting

confidence: 92%

“…Their risk factor was age, and in 3/5 high serum Creatinine at admission, they all survived without persistent renal failure and left hospital in good shape. One patient died (1/28), which seems to be a low mortality rate compared with other studies [20,21]. Boey showed, in a prospective study of 250 patients with perforated duodenal ulcers, that major medical illness (ASA score 4 & 5) preoperative shock and delayed surgery were accurate predictors of mortality [22].…”

Section: Fig 4 C-reactive Protein (Crp)mentioning

confidence: 99%

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Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study

et al. 2020

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Background Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial. Methods All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2–3 weeks. Complications were recorded and classified according to Clavien-Dindo (C-D). Results 43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5 years (23–91) with no difference between groups. ASA score was unevenly distributed between the groups (p = 0.069). Operation time was significantly shorter in the stent group, 68 min (48–107) versus 92 min (68–154) (p = 0.001). Stents were removed after a median of 21 days (11–37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2–5) (n.s.). Conclusions Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Fig 4 C-reactive Protein (Crp)mentioning

confidence: 99%

Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study

et al. 2020

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“…Many studies have demonstrated the feasibility and efficacy of LSC. They demonstrated that laparoscopic repair results in lower postoperative analgesic use, earlier discharge, and equal outcomes compared with open repair [6e8, 12,13].…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with conversion of laparoscopic simple closure in perforated duodenal ulcer

Kim

Chin

Bae

et al. 2015

International Journal of Surgery

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“…Laparoscopic repair has many advantages over open repair with early oral food intake, shorter duration of hospital stay, lower incidence of wound infections in adition to general reduction in postoperative morbidity and mortality [15]. Many previous studies proved the safety and several advantages of laparoscopy over open surgery [16]. Although using laparoscopy was proposed by Lagoo et al, [17] in 1992 to be used routinely in management of PPU but, up-till, open surgery is still a method of choice for PPU repair although the laparoscopic repair is safe and have many benefits due to many factors (1) the low incidence of PPU that lead to reduction in rate of exposure to cases that need surgical intervention (2) absence of well qualified surgeons on-duty all the time in hospitals for treatment of PPU patients (3) absence of laparoscopic experience of the surgeon could result in a high rate of conversion to open surgery.…”

Section: Results:-mentioning

confidence: 99%

Laparoscopy as a Suitable and Safe Alternative to Open Surgery in Management of Perforated Peptic Ulcer: A Comparative Study.

AbdElhady¹

2019

IJAR

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Background: Laparoscopic surgeries become the gold standard procedure of management of many elective surgical problems, but its role in acute emergent surgical problems as in perforated peptic ulcer (PPU) management has been still controversial and needs further evaluation. The aim of the present study was to compare between laparoscopic repair and open repair for the surgical management of PPU to give an evidence-based clue for selecting most appropriate surgical management technique. Patients and Methods: in the current study we included 30 patients which were divided into 2 groups; group 1 included 15 patients where we managed them by laparoscopic simple closure of the perforation with an omental patch and group 2 included 15 patients where we performed simple closure of the perforation with an omental patch through open surgery. Results: There is statistically significant association between both groups regarding duration of hospital stay (days), presence of surgical site infection, postoperative morbidity (p<0.001), postoperative mortality (p= 0.009) (more in the open group), clinical cure without complication (less in the open group) (p=0.002). Conclusions: Our study clarified the benefits of laparoscopic repair of PPU than open surgical repair of PPU regarding less postoperative pain, infection, morbidities, mortality and shorter duration of hospitalization in comparison with open repair.

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A Comparison of Laparoscopic Versus Open Repair for the Surgical Treatment of Perforated Peptic Ulcers

Cited by 5 publications

References 26 publications

Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study

Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study

Risk factors associated with conversion of laparoscopic simple closure in perforated duodenal ulcer

Laparoscopy as a Suitable and Safe Alternative to Open Surgery in Management of Perforated Peptic Ulcer: A Comparative Study.

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