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A comparison of short-term outcomes between laparoscopic and open emergent repair of perforated peptic ulcers

  • Daniel L. Davenport
  • Walker R. Ueland
  • Shyanie Kumar
  • Margaret Plymale
  • Andrew C. Bernard
  • J. Scott Roth
Article

Abstract

Background

We compared 30-day outcomes in patients undergoing emergent open and laparoscopic repair of perforated peptic ulcers in a large multicenter cohort.

Methods

Prospectively obtained data in the American College of Surgeons National Surgical Quality Improvement Program public use files from 2010 to 2016 were reviewed. Perioperative risks and outcomes were compared in unmatched and propensity-matched groups using parametric/non-parametric statistical tests as appropriate.

Results

A total of 4210 procedures were identified 345 (8.2%) laparoscopic and 3865 (91.8%) open. Laparoscopic repairs increased from 4.5% of 2010 cases to 11.4% of 2016 cases (p < .001). Open repair patients had more acute presentation including higher rates of ASA class, hypoalbuminemia, preoperative septic shock, dyspnea, and mechanical ventilation (all p < .01). Laparoscopic operations were longer than open procedures (p < .001). Mortality (8.5 vs. 3.5%), median length of stay (7 vs. 5 days), transfusion rates (13.7 vs. 7.0%), renal failure (3.7 vs. 1.2%), and respiratory failure (15.5 vs. 5.2%) were all worse in the unmatched open group (all p < .01). Propensity matching resulted in 342 laparoscopic and 626 open cases of similar ulcer type, demographics, ASA class, preoperative SIRS/sepsis, hypoalbuminemia, and wound class. Mortality was similar between matched groups (5.0 vs. 3.5%, p = .331). Median length of stay was longer in the open group (6 vs. 5 days, p < .001), which also had higher rates of prolonged ventilation/reintubation (9.6 vs. 5.3%, p = .019) and abdominal wall wound occurrences (6.2 vs. 2.3%, p = .042). Return to the operating room and 30-day readmissions did not differ between the matched groups.

Conclusions

Emergent laparoscopic repair of perforated peptic ulcer is increasingly being performed, is safe relative to open repair (in patients without preoperative septic shock), and confers a modest benefit in terms of length of stay, respiratory, and abdominal wall wound complications.

Keywords

Perforated peptic ulcer Outcomes Laparoscopic repair Open repair 

Notes

Compliance with ethical standards

Disclosure

Dr. Bernard has a consulting relationship with Atos Bio for clinical trial data adjudication and does expert witness case review and provides testimony in medical malpractice cases. Dr. Bernard is the President of the Eastern Association for the Surgery of Trauma and receives free travel for association-related meetings and events. Dr. Roth has a consulting relationship with Bard, Allergan, and Miromatrix. He is a participant on a speaking bureau for Bard and Miromatrix. He has some stock ownership in Miromatrix. He receives research funding from Bard. Drs. Plymale, Davenport and Kumar and Mr. Ueland have no conflicts of interest or financial interests to disclose.

References

  1. 1.
    Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122:1500–1511CrossRefPubMedGoogle Scholar
  2. 2.
    Epperson J (2006) Immunization and infectious diseases. In: Robeson S, Owens L (eds) Kentucky Cabinet for Health and Family Services 2010 Mid-decade Review, Frankfort, pp 324–342Google Scholar
  3. 3.
    Peterson WL (1991) Helicobacter pylori and peptic ulcer disease. New Engl J Med 324:1043–1048CrossRefPubMedGoogle Scholar
  4. 4.
    Wakayama T, Ishizaki Y, Mitsusada M, Takahashi S, Wada T, Fukushima Y, Hattori H, Okuyama T, Funatsu H (1994) Risk factors influencing the short-term results of gastroduodenal perforation. Surg Today 24:681–687CrossRefPubMedGoogle Scholar
  5. 5.
    Wallace JL (2008) Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn’t the stomach digest itself? Physiol Rev 88:1547–1565CrossRefPubMedGoogle Scholar
  6. 6.
    Huang JQ, Sridhar S, Hunt RH (2002) Role of Helicobacter pylori infection and non-steroidal anti- inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 359:14–22CrossRefPubMedGoogle Scholar
  7. 7.
    Wang YR, Richter JE, Dempsey DT (2010) Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg 251:51–58CrossRefPubMedGoogle Scholar
  8. 8.
    Lee CW, Sarosi GA (2011) Emergency ulcer surgery. Surg Clin North Am 91:1001–1013.  https://doi.org/10.1016/j.suc.2011.06.008 CrossRefPubMedGoogle Scholar
  9. 9.
    Boey J, Wong J, Ong GB (1982) A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg 195:265–269CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Thorson K, Soreide JA, Soreide K (2014) What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg 18:1261–1268CrossRefGoogle Scholar
  11. 11.
    Unver M, Firat O, Unalp OV, Uguz A, Gumus T, Sezer TO, Öztürk Ş, Yoldaş T, Ersin S, Güler A (2015) Prognostic factors in peptic ulcer perforations: a retrospective 14-year study. Int Surg 100:942–948CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bertleff MJ, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc 24:1231–1239CrossRefPubMedGoogle Scholar
  13. 13.
    Sanabria A, Morales CH, Villegas M (2005) Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev 4:CD004778Google Scholar
  14. 14.
    Di Saverio S, Bassi M, Smeireri N, Masetti M, Ferrara F, Fabbri C, Ansaloni L, Ghersi S, Serenari M, Coccolini F, Naidoo N, Sartelli M, Tugnoli G, Catena F, Cennamo V, Jovine E (2014) Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg 9:45CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lau WY, Leung KL, Zhu XL, Lam YH, Chung SC, Li AK (1995) Laparoscopic repair of perforated peptic ulcer. Br J Surg 82:814–816CrossRefPubMedGoogle Scholar
  16. 16.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2013) Meta-analysis of laparoscopic versus open repair of perforated peptic ulcer. JSLS 17:14–22CrossRefGoogle Scholar
  17. 17.
    Lagoo S, McMahon RL, Kakihara M, Pappas TN, Eubanks S (2002) The sixth decision regarding perforated duodenal ulcer. JSLS 6:359–368PubMedPubMedCentralGoogle Scholar
  18. 18.
    Muller MK, Wrann S, Widmer J, Klasen J, Weber M, Hahnloser D (2016) Perforated peptic ulcer repair: factors predicting conversion in laparoscopy and postoperative septic complication. World J Surg 40:2186–2193CrossRefPubMedGoogle Scholar
  19. 19.
    Bertleff MJ, Halm JA, Bemelman WA, van der Ham AC, van der Harst E, Oei HI, Smulders JF, Steyerberg EW, Lange JF (2009) Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA trial. World J Surg 33:1368–1373CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Siu WT, Leong BK, Law BK, Chau CH, Li AC, Fung KH, Tai YP, Li MK (2002) Laparoscopic repair for perforated ulcer. A randomized controlled trial. Ann Surg 235:313–319CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tan S, Wu G, Zhuang Q, Xi Q, Meng Q, Jiang Y, Han Y, Yu C (2016) Laparoscopic versus open repair for perforated peptic ulcer: a meta analysis of randomized controlled trials. Int J Surg 33:124–132CrossRefPubMedGoogle Scholar
  22. 22.
    Varcus F, Paun I, Duta C, Dobrescu A, Frandes M, Tarta C (2018) Laparoscopic repair of perforated peptic ulcer. Minerva Chir 73:188–193PubMedGoogle Scholar
  23. 23.
    Lee JC, Peitzman AB (2006) Damage control laparotomy. Curr Opin Crit Care 12:346–350CrossRefPubMedGoogle Scholar
  24. 24.
    Teoh AY, Chiu PW, Kok AS, Wong SK (2015) The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer. World J Surg 39:740–745CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniel L. Davenport
    • 1
  • Walker R. Ueland
    • 2
  • Shyanie Kumar
    • 3
  • Margaret Plymale
    • 1
    • 4
  • Andrew C. Bernard
    • 1
    • 4
  • J. Scott Roth
    • 1
    • 4
  1. 1.Department of SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.College of MedicineUniversity of KentuckyLexingtonUSA
  3. 3.General Surgery Residency ProgramUniversity of KentuckyLexingtonUSA
  4. 4.Division of General SurgeryUniversity of KentuckyLexingtonUSA

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