Risk factors for leak after omentopexy for duodenal ulcer perforations

Dogra, Poornima; Kaushik, Robin; Singh, Simrandeep; Bhardwaj, Sushma

doi:10.1007/s00068-022-02058-y

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…The main cause for reoperation following surgical repair is suture leak. Proposed explanations, based on current literature data, include the difficulty in laparoscopic knot tying, ulcer diameter (> 2 cm) and abdominal contamination [ 49 , 50 ]. Based on our multivariate analysis the factors associated with leak were ulcer site (pyloric/duodenal), higher Boey Score and higher Age-shock index while PULP score revealed his statistically significant association with leakage only at the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Costa

Bianchi²,

Occhionorelli³

et al. 2023

Surg Endosc

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Background Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.

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Section: Discussionmentioning

confidence: 99%

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Costa

Bianchi²,

Occhionorelli³

et al. 2023

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…Suture leak is the most feared complication and the major cause of reoperation after surgical repair. Proposed explanations from the current literature include difficulties in laparoscopic knot tying, ulcer diameter (>2 cm), and abdominal contamination [ 53 , 54 ]. Our previous multivariate analysis identified the ulcer site (pyloric/duodenal), a higher Boey Score, and a higher Age–Shock Index as factors associated with leaks [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture

Costa,

Garbarino,

Lepre

et al. 2024

JCM

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Background: Peptic ulcers result from imbalanced acid production, and in recent decades, proton pump inhibitors have proven effective in treating them. However, perforated peptic ulcers (PPU) continue to occur with a persistent high mortality rate when not managed properly. The advantages of the laparoscopic approach have been widely acknowledged. Nevertheless, concerning certain technical aspects of this method, such as the best gastrorrhaphy technique, the consensus remains elusive. Consequently, the choice tends to rely on individual surgical experiences. Our study aimed to compare interrupted stitches versus running barbed suture for laparoscopic PPU repair. Methods: We conducted a retrospective study utilizing propensity score matching analysis on patients who underwent laparoscopic PPU repair. Patients were categorised into two groups: Interrupted Stitches Suture (IStiS) and Knotless Suture (KnotS). We then compared the clinical and pathological characteristics of patients in both groups. Results: A total of 265 patients underwent laparoscopic PPU repair: 198 patients with interrupted stitches technique and 67 with barbed knotless suture. Following propensity score matching, each group (IStiS and KnotS) comprised 56 patients. The analysis revealed that operative time did not differ between groups: 87.9 ± 39.7 vs. 92.8 ± 42.6 min (p = 0.537). Postoperative morbidity (24.0% vs. 32.7%, p = 0.331) and Clavien–Dindo III (10.7% vs. 5.4%, p = 0.489) were more frequently observed in the KnotS group, without any significant difference. In contrast, we found a slightly higher mortality rate in the IStiS group (10.7% vs. 7.1%, p = 0.742). Concerning leaks, no differences emerged between groups (3.6% vs. 5.4%, p = 1.000). Conclusions: Laparoscopic PPU repair with knotless barbed sutures is a non-inferior alternative to interrupted stitches repair. Nevertheless, further research such as randomised trials, with a standardised treatment protocol according to ulcer size, are required to identify the best gastrorraphy technique.

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Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis

Chaouch,

Khalfallah,

Jabra

et al. 2024

Updates Surg

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Risk factors for leak after omentopexy for duodenal ulcer perforations

Cited by 3 publications

References 28 publications

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture

Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis

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