Laparoscopic versus open repair of perforated duodenal peptic ulcer: a randomized controlled trial

Zedan, Adel; Lolah, Magdi A; Badr, Mohammed L; Ammar, Mohammed S

doi:10.4103/1110-2098.155945

Cited by 8 publications

(10 citation statements)

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“…The significant rate of pneumonia (18% in open, 0% in laparoscopic), may be explained by the fact that performing an upper abdominal incision limits the respiratory effort of the patient due to increased postoperative pain, which then leads to atelectasis and other complications. This has also been commonly demonstrated by previous studies [ 29 , 33 , 34 ]. Despite comparable large perforation sizes in both groups, there were no cases of leakage, intraabdominal fluid collection, need for re-exploration or mortality in the laparoscopic group.…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2022

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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

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Section: Discussionsupporting

confidence: 88%

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

et al. 2022

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“…Of course, these cases were properly resuscitated before transfer to the operative theater. In another study, Zedan et al (10) has reported that shock was present in 12.5 and 9.5% of cases in the laparotomy and laparoscopic groups respectively, without any significant difference between the study groups (p =-0.75).…”

Section: Discussionmentioning

confidence: 89%

“…On the contrary, Zedan and his colleagues (10) reported that the duration of operation was significantly shorter in the laparotomy group (110 vs. 145 minutes in the laparoscopic groupp = 0.0001). Moreover, a previous meta-analysis confirmed the prolonged operative time in laparotomy group versus laparoscopic one (94 vs. 135 minutesp < 0.05) 14 .…”

Section: Discussionmentioning

confidence: 90%

“…Similarly, another study confirmed our findings regarding decreased pain scores in the laparoscopic approach group (4.4 vs. 7 in the laparotomy group, p = 0.0001). As a result, opioid consumption was significantly decreased in the laparoscopic group (p < 0.001) 10 . in addition, Lau et al (16) in their metaanalysis reported significant decrease in opioid analgesic requirement in 8 of the included studies.…”

Section: Discussionmentioning

confidence: 91%

“…In line with our findings, another Egyptian study has reported a mean age near to ours. The mean age of the included cases was 42 and 40 years in the laparotomy and laparoscopic groups respectively (p = 0.55) 10 .…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopy Versus Laparotomy in The Surgical Treatment of Perforated Duodenal Ulcers

El-Din

2020

The Egyptian Journal of Hospital Medicine

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Background: There is no clear consensus about whether laparoscopy or laparotomy is more beneficial in managing perforations of duodenal ulcers. Objective: The study was performed to compare between laparotomy and laparoscopic approaches in managing perforations of duodenal ulcers regarding operative time and early operative outcomes. Patient and methods: This randomized comparative prospective study included 84 cases diagnosed with perforated duodenal ulcer, they were divided into two equal groups: laparotomy and laparoscopic groups (42 cases for each). All cases were clinically and radiologically assessed. Operative time was our primary outcome, while secondary outcomes included post-operative pain, analgesic consumption, hospitalization time, and complications of both techniques. Results: No significance in differences were reported between the two groups regarding patient demography. Both smoking history and analgesic use were reported by most cases in both groups. The operative time (p = 0.082) was not significantly different between the two groups. The laparoscopic group showed less pain scores, less morphine needs, earlier oral fluid intake, and short hospitalization time in comparison to the laparotomy group. Also, the wound infection incidence was significantly higher in the laparotomy group. Conclusion:The laparoscopic approach appears to be more safe and efficacious in the surgical treatment of perforations of duodenal ulcers, as it is associated with less peri-operative complications and shorter hospitalization time with a comparable operation time in comparison to laparotomy.

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A 1-Year Randomized Controlled Study to Compare Laparoscopic Repair vs. Open Repair for the Treatment of Hollow Viscus Perforation

et al. 2018

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Laparoscopic versus open repair of perforated duodenal peptic ulcer: a randomized controlled trial

Cited by 8 publications

References 0 publications

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

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

Laparoscopy Versus Laparotomy in The Surgical Treatment of Perforated Duodenal Ulcers

A 1-Year Randomized Controlled Study to Compare Laparoscopic Repair vs. Open Repair for the Treatment of Hollow Viscus Perforation

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