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Perforated Peptic Ulcer Repair: Factors Predicting Conversion in Laparoscopy and Postoperative Septic Complications

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Abstract

Objective

The surgical treatment for perforated peptic ulcers can be safely performed laparoscopically. The aim of the study was to define simple predictive factors for conversion and septic complications.

Methods

This retrospective case–control study analyzed patients treated with either laparoscopic surgery or laparotomy for perforated peptic ulcers.

Results

A total of 71 patients were analyzed. Laparoscopically operated patients had a shorter hospital stay (13.7 vs. 15.1 days). In an intention-to-treat analysis, patients with conversion to open surgery (analyzed as subgroup from laparoscopic approach group) showed no prolonged hospital stay (15.3 days) compared to patients with a primary open approach. Complication and mortality rates were not different between the groups. The statistical analysis identified four intraoperative risk factors for conversion: Mannheim peritonitis index (MPI) > 21 (p = 0.02), generalized peritonitis (p = 0.04), adhesions, and perforations located in a region other than the duodenal anterior wall. We found seven predictive factors for septic complications: age >70 (p = 0.02), cardiopulmonary disease (p = 0.04), ASA > 3 (p = 0.002), CRP > 100 (p = 0.005), duration of symptoms >24 h (p = 0.02), MPI > 21(p = 0.008), and generalized peritonitis (p = 0.02).

Conclusion

Our data suggest that a primary laparoscopic approach has no disadvantages. Factors necessitating conversions emerged during the procedure inhibiting a preoperative selection. Factors suggesting imminent septic complications can be assessed preoperatively. An assessment of the proposed parameters may help optimize the management of possible septic complications.

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Authors’ contributions

MKM, MW, and DH collected data. MKM and DH designed the study, made the statistical analysis, and performed the draft of the manuscript; MKM and SW wrote the manuscript. SW performed major revisions. JW and JK revised the manuscript.

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    Authors and Affiliations

    1. Department of Surgery, Cantonal Hospital of Frauenfeld, 8500, Frauenfeld, Switzerland

      Markus K. Muller, Simon Wrann, Jeannette Widmer & Jennifer Klasen

    2. Department of Surgery, Central City Hospital Triemli of Zurich, Zurich, Switzerland

      Markus Weber

    3. Department of Surgery, University Hospital of Lausanne, Lausanne, Switzerland

      Dieter Hahnloser

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    1. Markus K. Muller
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    Correspondence to Markus K. Muller.

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    Markus K. Müller, Simon Wrann, Jeannette Widmer, Jennifer Klasen, Markus Weber, and Dieter Hahnloser have no conflict of interest or financial ties to disclose.

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    Markus K. Muller and Simon Wrann contributed equally to this work.

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    Muller, M.K., Wrann, S., Widmer, J. et al. Perforated Peptic Ulcer Repair: Factors Predicting Conversion in Laparoscopy and Postoperative Septic Complications. World J Surg 40, 2186–2193 (2016). https://doi.org/10.1007/s00268-016-3516-z

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    • DOI: https://doi.org/10.1007/s00268-016-3516-z

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