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Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study

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Abstract

Purpose

A perforated peptic ulcer can be managed laparoscopically in selected patients. The purpose of this study was to evaluate whether conversion of emergency laparoscopy is inferior to primary median laparotomy in terms of postoperative morbidity and mortality.

Methods

We analyzed patients who underwent laparoscopic or open surgery for a perforated peptic ulcer at the Department of Surgery, University of Schleswig–Holstein, Campus Luebeck between January, 1996 and December, 2010. Perforations were graded according to the Boey classification, a preoperative risk-scoring system.

Results

Conversion to laparotomy was necessary in 20 of the 45 patients who underwent laparoscopic surgery (CG); therefore, laparoscopic operations were completed in 25 patients (LG). The third patient cohort comprised 139 patients who underwent primary laparotomy (OG). Overall minor morbidity was significantly lower (p = 0.048) in the LG patients than in the OG patients, whereas no significant differences were found in major morbidity and mortality, particularly between the OG and CG.

Conclusion

Patients’ suitability for laparoscopic management should be decided on according to Boey’s clinical scoring system. Our findings demonstrated that conversion from laparoscopy to laparotomy was not associated with elevated postoperative morbidity or mortality versus initial laparotomy. Therefore, emergency operations may be commenced laparoscopically in selected patients, especially considering the postoperative advantages of this approach.

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Conflict of interest

M. Zimmermann, M. Hoffmann, T. Laubert, C. Jung, H.-P. Bruch and E. Schloericke have no conflicts of interest or financial ties to disclosure.

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Authors and Affiliations

  1. Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany

    Markus Zimmermann, Martin Hoffmann, Tilman Laubert, Carlo Jung & Hans-Peter Bruch

  2. Westküstenklinikum, Heide Esmarchstraße 50, 25746, Heide, Germany

    Erik Schloericke

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  1. Markus Zimmermann
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  2. Martin Hoffmann
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Correspondence to Markus Zimmermann.

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Zimmermann, M., Hoffmann, M., Laubert, T. et al. Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study. Surg Today 45, 1421–1428 (2015). https://doi.org/10.1007/s00595-015-1112-8

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  • DOI: https://doi.org/10.1007/s00595-015-1112-8

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