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Surgical Endoscopy

, Volume 28, Issue 8, pp 2302–2308 | Cite as

Laparoscopic repair of perforated peptic ulcer: single-center results

  • Simone GuadagniEmail author
  • Ismail Cengeli
  • Christian Galatioto
  • Niccolò Furbetta
  • Vincenzo Lippolis Piero
  • Giuseppe Zocco
  • Massimo Seccia
Article

Abstract

Background

Perforated peptic ulcer (PPU), the most common indication for emergency gastric surgery, is associated with high morbidity and mortality rates. Outcomes might be improved by performing this procedure laparoscopically, but no consensus exists on whether the benefits of laparoscopic repair (LR) of PPU outweigh the disadvantages.

Methods

From January 2002 to December 2012, 111 patients underwent surgery for perforated ulcer. A “laparoscopy-first” policy was attempted and then applied for 56 patients. The exclusion criteria for LR ruled out patients who had shock at admission, severe cardiorespiratory comorbidities, or a history of supramesocolic surgery. The aim of this study was a retrospective analysis of the 56 patients treated laparoscopically.

Results

The patient distribution was 30 men and 26 women, who had a mean age of 59 years (range 19–95 years). The mean ulcer size was 10 mm, and the Mannheim peritonitis index (MPI) was 21. LR was performed for 39 (69.6 %) of the 56 patients and included peritoneal lavage, suturing of the perforation, and omental patching. Conversion to laparotomy was necessary in 17 cases (30.4 %). The “conversion group” showed significant differences in ulcer size (larger ulcers: 1.9 vs 0.7 mm; p < 0.01), ulcer-site topography (higher incidence of posterior ulcers: 5 vs 0; p < 0.01), and MPI score (higher score: 24 vs 20; p < 0.05). The LR group had a mean operating time of 86 min (range 50–125 min), an in-hospital morbidity rate of 7.6 %, a mortality rate of 2.5 %, and a mean hospital stay of 6.7 days (range 5–12 days). None of these patients required reintervention.

Conclusions

The results showed that LR for PPU is feasible with acceptable mortality and morbidity rates. Skill in laparoscopic abdominal emergencies is required. Perforations 1.5 cm or larger, posterior duodenal ulcers, and an MPI higher than 25 should be considered the main risk factors for conversion.

Keywords

Laparoscopic surgery Omentoplasty Perforated peptic ulcer Suture 

Notes

Disclosures

Simone Guadagni, Ismail Cengeli, Christian Galatioto, Niccolò Furbetta, Vincenzo Lippolis Piero, Giuseppe Zocco, and Massimo Seccia have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Svanes C (2000) Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg 24:277–283PubMedCrossRefGoogle Scholar
  2. 2.
    Mouret P, Francois Y, Vignal J, Barth X, Lombard-Platet R (1990) Laparoscopic treatment of perforated peptic ulcer. Br J Surg 77:1006PubMedCrossRefGoogle Scholar
  3. 3.
    Bertleff MJOE, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24:1231–1239PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Ding J, Liao GQ, Zhang ZM, Pan Y, Li DM, Wang RH, Xu KS, Yang XF, Yuan P, Wang SY (2011) Meta-analysis of laparoscopic and open repair of perforated peptic ulcer. Zhonghua Wei Chang Wai Ke Za Zhi 14:785–789PubMedGoogle Scholar
  5. 5.
    Robertson GS, Wemyss-Holden SA, Maddern GJ (2000) Laparoscopic repair of perforated duodenal ulcers: the role of laparoscopy in generalized peritonitis. Ann R Coll Surg Engl 82:6–10PubMedCentralPubMedGoogle Scholar
  6. 6.
    Bergamaschi R, Marvik R, Johnsen G, Thoresen JE, Ystgaard B, Myrvold HE (1999) Open vs laparoscopic repair of perforated peptic ulcer. Surg Endosc 13:679–682PubMedCrossRefGoogle Scholar
  7. 7.
    Michelet I, Agresta F (2000) Perforated peptic ulcer: laparoscopic approach. Eur J Surg 166:405–408PubMedCrossRefGoogle Scholar
  8. 8.
    Naesgaard JM, Edwin B, Reiertsen O, Trondsen E, Faerden AE, Rosseland AR (1999) Laparoscopic and open operation in patients with perforated peptic ulcer. Eur J Surg 165:209–214PubMedCrossRefGoogle Scholar
  9. 9.
    Feussner H, Siewert JR (2001) Reduction of surgical access trauma: reliable advantages. Chirurg Mar 72:236–244CrossRefGoogle Scholar
  10. 10.
    Gál I, Róth E, Lantos J, Varga G, Jaberansari MT (1997) Inflammatory mediators and surgical trauma regarding laparoscopic access: free radical mediated reactions. Acta Chir Hung 36:97–99PubMedGoogle Scholar
  11. 11.
    Arnaud JP, Tuech JJ, Bergamaschi R, Pessaux P, Regenet N (2002) Laparoscopic suture closure of perforated duodenal peptic ulcer. Surg Laparosc Endosc Percutan Tech 12:145–147PubMedCrossRefGoogle Scholar
  12. 12.
    Druart ML, Van Hee R, Etienne J, Cadière GB, Gigot JF, Legrand M, Limbosch JM, Navez B, Tugilimana M, Van Vyve E, Vereecken L, Wibin E, Yvergneaux JP (1997) Laparoscopic repair of perforated duodenal ulcer: a prospective multicenter clinical trial. Surg Endosc 11:1017–1020PubMedCrossRefGoogle Scholar
  13. 13.
    Siu WT, Leong HT, Law BKB, Chau CH, Li CAN, Fung KH, Tai YP, Li MKW (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235:313–319PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Lee FY, Leung KL, Lai PB, Lau JW (2001) Selection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg 88:133–136PubMedCrossRefGoogle Scholar
  15. 15.
    Siu WT, Chau CH, Law BK, Tang CN, Ha PY, Li MK (2004) Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg 91:481–484PubMedCrossRefGoogle Scholar
  16. 16.
    Lunevicius R, Morkevicius M (2005) Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. Br J Surg 92:1195–1207PubMedCrossRefGoogle Scholar
  17. 17.
    Wong DC, Siu WT, Wong SK, Tai YP, Li MK (2009) Routine laparoscopic single-stitch omental patch repair for perforated peptic ulcer: experience from 338 cases. Surg Endosc 23:457–458PubMedCrossRefGoogle Scholar
  18. 18.
    Song K-Y, Kim T-H, Kim S-N, Park C-H (2008) Laparoscopic repair of perforated duodenal ulcers: the simple one-stitch suture with omental patch technique. Surg Endosc 22:1632–1635PubMedCrossRefGoogle Scholar
  19. 19.
    Seelig MH, Seelig SK, Behr C, Schonleben K (2003) Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers. J Clin Gastroenterol 37:226–229PubMedCrossRefGoogle Scholar
  20. 20.
    Mehendale VG, Shenoy SN, Joshi AM, Chaudhari NC (2002) Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study. Indian J Gastroenterol 21:222–224PubMedGoogle Scholar
  21. 21.
    Lau H (2004) Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc 18:1013–1021PubMedGoogle Scholar
  22. 22.
    Michelet I, Agresta F (2000) Perforated peptic ulcer: laparoscopic approach. Eur J Surg 166:405–408PubMedCrossRefGoogle Scholar
  23. 23.
    Cellan-Jones CJ (1929) A rapid method of treatment in perforated duodenal ulcer. Br Med J 1:1076–1077PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Schein M (2005) Perforated peptic ulcer: Schein’s common sense emergency abdominal surgery. Springer, Berlin, pp 143–150Google Scholar
  25. 25.
    Gurtner GC, Robertson CS, Chung SC, Ling TK, Ip SM, Li AK (1995) Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxemia in an animal model of peritonitis. Br J Surg 82:844–848PubMedCrossRefGoogle Scholar
  26. 26.
    Robertson GS, Wemyss-Holden SA, Maddern GJ (2000) Laparoscopic repair of perforated duodenal ulcers: the role of laparoscopy in generalised peritonitis. Ann R Coll Surg Engl 82:6–10PubMedCentralPubMedGoogle Scholar
  27. 27.
    Ates M, Coban S, Sevil S, Terzi A (2008) The efficacy of laparoscopic surgery in patients with peritonitis. Surg Laparosc Endosc Percutan Tech 18:453–456PubMedCrossRefGoogle Scholar
  28. 28.
    Katkhoda N, Mavor E, Mason RJ (1999) Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134:845–850CrossRefGoogle Scholar
  29. 29.
    Lagoo S, McMahon RL, Kakihara M, Pappas TN, Eubanks S (2002) The sixth decision regarding perforated duodenal ulcer. JSLS 6:359–368PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Simone Guadagni
    • 1
    Email author
  • Ismail Cengeli
    • 1
  • Christian Galatioto
    • 1
  • Niccolò Furbetta
    • 1
  • Vincenzo Lippolis Piero
    • 1
  • Giuseppe Zocco
    • 1
  • Massimo Seccia
    • 1
  1. 1.Emergency Surgery Unit, Department of Emergency and AcceptanceUniversity of PisaPisaItaly

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