Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair

Quah, Gaik Si; Eslick, Guy D.; Cox, Michael R.

doi:10.1007/s11605-018-4047-8

Cited by 61 publications

(66 citation statements)

References 51 publications

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“…The previously discovered disadvantage of laparoscopic repair of PPU was the longer operating time but due to increasing the laparoscopic expertise and novel techniques, we found no statistically significant differences between open and laparoscopic repair. We found similar results to Quah et al [1], meta-analysis who provided an obvious evidence that laparoscopic repair is a safe method that could be safely used in treating PPU when compared with the open repair. Moreover, we found that there was increased risk of post-operative leakage or sepsis.…”

Section: Results:-supporting

confidence: 89%

“…But previous studies which assessed the benefits of using laparoscopic management of generalized peritonitis disproved that past theory [11]. In the present study we demonstrated no significant differences in the occurrence of sepsis or increasing incidence of leakage or intra-abdominal collections in laparoscopic repair than open repair of PPU, this was nearly similar to Quah et al [1] the rate of leakage occurrence was markedly lower than that showed in previous studies [12]. The reduction in rates of leakage is due to improved laparoscopic techniques, equipment and laparoscopic surgical experiences.…”

Section: Results:-supporting

confidence: 88%

“…In the current study we showed that laparoscopic repair of PPU is better than open repair of such surgical problem with a significant decrease in postoperative morbidity, pain, wound infection and rabid recovery. Similarly, the results of Quah et al [1], in their meta-analysis, and results of Li et al, [2].…”

Section: Results:-mentioning

confidence: 70%

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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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Section: Results:-supporting

confidence: 89%

Section: Results:-supporting

confidence: 88%

See 1 more Smart Citation

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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“…Surgical repair can be performed either with conventional open surgery or with laparoscopy. The results of a recent meta-analysis including seven randomized controlled trials showed a significant benefit for the laparoscopic approach for the treatment of perforated peptic ulcer disease with a significant reduction in postoperative complications and hospital stay [58].…”

Section: Simple Surgical Repairmentioning

confidence: 99%

Diagnosis and management of duodenal perforations: a narrative review

Ansari

Torén

Lindberg

et al. 2019

Scandinavian Journal of Gastroenterology

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Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies. ARTICLE HISTORY

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“…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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Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair

Cited by 61 publications

References 51 publications

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

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

Diagnosis and management of duodenal perforations: a narrative review

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

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