Laparoscopic Repair of Perforated Duodenal Ulcers

Katkhouda, Namir; Mavor, Eli; Mason, Rodney J.; Campos, Guilherme M.; Soroushyari, Ardeshir; Berne, Thomas V.

doi:10.1001/archsurg.134.8.845

Cited by 88 publications

(36 citation statements)

References 20 publications

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“…Theoretically there is a preference for intracorporeal knotting over extracorporeal suturing, because the latter is likely to cut through the friable edge of the perforation [12]. One of the disadvantages of laparoscopic correction of PPU often mentioned was the significant longer operating time, which causes more costs and may be nonpreferable in a hemodynamically unstable patient [5, 16, 18, 35, 42, 43, 45, 46]. Ates et al presented results with simple suture repair of PPU without using pedicled omentoplasty [11].…”

Section: Discussionmentioning

confidence: 99%

“…The maximum score is 3, which indicates high surgical risk. Laparoscopic repair is reported only to be safe with Boey score 0 and 1 [16, 42]. Since the incidence of patients with Boey score 2 and 3 is low (according to Table 2, only 2% of patients were admitted with Boey score 3, 7% were in shock at admission, and 11% had prolonged symptoms for more than 24 h) and Boey 2 and 3 is associated with high morbidity and mortality rate anyway, independent of type of surgery, it is difficult to find significant foundation for this statement.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

2009

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BackgroundPerforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense.MethodsAn electronic literature search was done by using PubMed and EMBASE databases. Relevant papers written between January 1989 and May 2009 were selected and scored according to Effective Public Health Practice Project guidelines.ResultsData were extracted from 56 papers, as summarized in Tables 1–7. The overall conversion rate for laparoscopic correction of perforated peptic ulcer was 12.4%, with main reason for conversion being the diameter of perforation. Patients presenting with PPU were predominantly men (79%), with an average age of 48 years. One-third had a history of peptic ulcer disease, and one-fifth took nonsteroidal anti-inflammatory drugs (NSAIDs). Only 7% presented with shock at admission. There seems to be no consensus on the perfect setup for surgery and/or operating technique. In the laparoscopic groups, operating time was significant longer and incidence of recurrent leakage at the repair site was higher. Nonetheless there was significant less postoperative pain, lower morbidity, less mortality, and shorter hospital stay. ConclusionThere are good arguments that laparoscopic correction of PPU should be first treatment of choice. A Boey score of 3, age over 70 years, and symptoms persisting longer than 24 h are associated with higher morbidity and mortality and should be considered contraindications for laparoscopic intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

2009

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“…2 , 3 , 5 - 10 Besides its established role in elective upper gastrointestinal surgery, it is being attempted in patients with generalized peritonitis and accompanying severe physiological disturbances. 11 , 12 Many published reports have shown that laparoscopic peritoneal lavage can be effectively performed and perforations can be closed safely.…”

Section: Introductionmentioning

confidence: 99%

Role of laparoscopy in peritonitis

Sangrasi¹,

Talpu²,

Kella³

et al. 2013

Pak J Med Sci

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Objective: Laparoscopy has gained clinical acceptance in many subspecialties in the last decade. The conventional open surgery for peritonitis carries significant morbidity and mortality. The present study was done to extend and evaluate benefits of minimally invasive surgery in this subset of patients. Methods: This was a prospective study spanning over a period of four years. All those patients diagnosed as having peritonitis on clinical assessment and preoperative investigations and those who were stable enough haemodynamically were included in this study. After initial resuscitation for few hours, they underwent diagnostic and therapeutic laparoscopy to identify the cause of peritonitis and to confirm the pathology. All cases were done under general anesthesia, using three standard ports at appropriate sites according to pathology. Patients were treated by different procedures either laparoscopically or with laparoscopic assistance after diagnosis. Operative and post operative data was collected and analyzed. Results: Ninety two cases of peritonitis underwent diagnostic and therapeutic laparoscopy. Mean age of patient was 46.5 years. 24 patients were diagnosed as perforated duodenal, in 14 (58.3%) patients laparoscopic suture repair was done and in 8 (33.3%) small upper midline incision was given and perforation was repaired. Out of 32 patients having perforated appendix, 25 (78.1%) patients laparoscopic appendectomy was done while in 7 (21.8%) perforation was dealt by laparoscopic assistance. Out of 14 patients of ileal perforation 6 (42.8%) with minimal contamination laparoscopic suture was applied, while in 8 (57.1%), perforated loop was brought out by making small window and perforation was closed. All 22 patients with pelvic sepsis needed only aspiration of pus and peritoneal lavage. Only one patient died post operatively and 2 (2.1%) patients developed fistula. 6 (6.5%) patients developed port site infection. Conclusion: Laparoscopic management is feasible, safe and effective surgical option for patients with peritonitis due to different abdominal emergencies in properly selected cases with higher diagnostic yield and a faster postoperative recovery.

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“…Randomized prospective studies have shown that postoperative hospital stay was shorter after laparoscopic repair but there is significant heterogeneity between these studies. Katkhouda et al suggested that patients undergoing laparoscopic repair with Taylor procedure re-sume normal diet earlier, while other studies failed to show significant differences [14].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Perforated Peptic Ulcer: Simple Closure or Something More?

Karydakis¹,

Семенов²,

Kyriakidis³

et al. 2016

OJGas

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Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2-6 hours from the onset of symptoms, 55 within 6-24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40-100 min for the Graham patch repair and 120-155 min for the Taylor procedure. During follow-up, 48% of patients from the "Graham patch" group and no one from the "definitive procedure" group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

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Laparoscopic Repair of Perforated Duodenal Ulcers

Cited by 88 publications

References 20 publications

Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

Role of laparoscopy in peritonitis

Laparoscopic Management of Perforated Peptic Ulcer: Simple Closure or Something More?

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