Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study

Zimmermann, Markus; Hoffmann, Martin; Laubert, Tilman; Jung, Carlo; Bruch, Hans–Peter; Schloericke, Erik

doi:10.1007/s00595-015-1112-8

Cited by 15 publications

(20 citation statements)

References 42 publications

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“…We observed that laparoscopic repair of PPU was accomplished in 29% of patients which is in line with recently published data reporting that laparoscopic repair is used in 3-33% of patients with PPU [6,8,9]. e conversion rate of this series (18,3%) is lower than other reports (25-44%) [8,9,16,17]. Mean operative time was longer in the laparoscopic group, as observed in these recent papers.…”

Section: Discussionsupporting

confidence: 91%

Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Pereira

Santos‐Sousa

Gonçalves

et al. 2021

Minimally Invasive Surgery

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Introduction. Laparoscopic repair of perforated peptic ulcer (PPU) remains controversial mainly due to its safety and applicability in critically ill patients. The aim of this study is to compare the outcomes of laparoscopy versus laparotomy in the treatment of PPU. Methods. Single-institutional, retrospective study of all patients submitted to surgical repair of PPU between 2012 and 2019. Results. During the study period, 169 patients underwent emergent surgery for PPU. A laparoscopic approach was tried in 60 patients and completely performed in 49 of them (conversion rate 18.3%). The open group was composed of 120 patients (included 11 conversions). Comparing the laparoscopic with the open group, there were significant differences in gender (male/female ratio 7.2/1 versus 2.2/1, respectively; p = 0.009 ) and in the presence of sepsis criteria (12.2% versus 38.3%, respectively; p = 0.001 ), while the Boey score showed no differences between the two groups. The operative time was longer in the laparoscopic group (median 100’ versus 80’, p = 0.01 ). Laparoscopy was associated with few early postoperative complications (18.4% versus 41.7%, p = 0.004 ), mortality (2.0% versus 14.2%; p = 0.02 ), shorter hospital stay (median 6 versus 7 days, p = 0.001 ), and earlier oral intake (median 3 versus 4 days, p = 0.021 ). Conclusion. Laparoscopic repair of PPU may be considered the procedure of choice in patients without sepsis criteria if expertise and resources are available. This kind of approach is associated with a shorter length of hospital stay and earlier oral intake. In patients with sepsis criteria, more data are required to access the safety of laparoscopy in the treatment of PPU.

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Section: Discussionsupporting

confidence: 91%

Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Pereira

Santos‐Sousa

Gonçalves

et al. 2021

Minimally Invasive Surgery

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“…On the other hand, for patients with PULP score ≥ 4, the operation time was significantly longer for the CL group than for the PL group (Table 6). Even though our results were in line with those reported in the literature that conversion did not negatively affect patient outcomes when compared to PL [14,23], the prolonged operation time required for conversion and higher costs incurred by the need for additional instruments were still negative impacts on operation room management. Some may favor the "laparoscopy-first" policy that as long as conversion does not increase the risk of major complications, the longer operation time and higher cost for conversion do not outweigh the benefit of a successful laparoscopic surgery [29,30].…”

Section: Figsupporting

confidence: 90%

“…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]. 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].…”

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 has a lesser rate of wound complications and faster recovery post-surgery, but the major morbidity and mortality remain the same. 30,31 Many of these patients recquire conversion to open surgery. However, with increasing expertise conversion rates are coming down and some dedicated laparoscopic teams are even showing a mortality of 2% in laparoscopic repair.…”

Section: Discussionmentioning

confidence: 99%

“…21,34 There are less surgical site complications in patients undergoing laparoscopic repair for PPU. [30][31][32] Zimmermann et al concluded that minor morbidity is less in laparoscopic approach but there was no difference in major morbidity or mortality compared to open surgery. Similar views have been put forward by Siow and Mahendran who had a morbidity of 22% in their laparoscopic series.…”

Section: Discussionmentioning

confidence: 99%

The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

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Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study

Cited by 15 publications

References 42 publications

Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

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

The outcome of surgery for perforated peptic ulcer in modern times

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