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Surgical Endoscopy

, Volume 33, Issue 1, pp 281–292 | Cite as

Surgical repair of perforated peptic ulcers: laparoscopic versus open approach

  • Victor VakayilEmail author
  • Brent Bauman
  • Keaton Joppru
  • Reema Mallick
  • Christopher Tignanelli
  • John Connett
  • Sayeed Ikramuddin
  • James V. HarmonJr.
2018 SAGES Oral
First Online:

Abstract

Introduction

Perforated peptic ulcers are a surgical emergency that can be repaired using either laparoscopic surgery (LS) or open surgery (OS). No consensus has been reached on the comparative outcomes and safety of each approach.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, we conducted a 12-year retrospective review (2005–2016) and identified 6260 adult patients who underwent either LS (n = 616) or OS (n = 5644) to repair perforated peptic ulcers. To mitigate selection bias and adjust for the inherent heterogeneity between groups, we used propensity-score matching with a case (LS):control (OS) ratio of 1:3. We then compared intraoperative outcomes such as operative time, and 30-day postoperative outcomes including infectious and non-infectious complications, and mortality.

Results

Propensity-score matching created a total of 2462 matched pairs (616 in the LS group, 1846 in the OS group). Univariate analysis demonstrated successful matching of patient characteristics and baseline clinical variables. We found that OS was associated with a shorter operative time (67.0 ± 28.6 min, OS versus 86.9 ± 57.5 min, LS; P < 0.001) but a longer hospital stay (8.6 ± 6.2 days, OS versus 7.8 ± 5.9 days, LS; P = 0.001). LS was associated with a lower rate of superficial surgical site infections (1.5%, LS versus 4.2%, OS; P = 0.032), wound dehiscence (0.3%, LS versus 1.6%, OS; P = 0.030), and mortality (3.2%, LS versus 5.4%, OS; P = 0.009).

Conclusion

Fewer than 10% of patients with perforated peptic ulcers underwent LS, which was associated with reduced length of stay, lower rate of superficial surgical site infections, wound dehiscence, and mortality. Given our results, a greater emphasis should be provided to a minimally invasive approach for the surgical repair of perforated peptic ulcers.

Keywords

Perforation Peptic ulcer Laparoscopic surgery Open surgery Omentoplasty 
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Notes

Acknowledgements

We thank the William Harmon Surgical Education and Research Fund for supporting our research. We also acknowledge and thank Mary Knatterud, PhD, for reviewing and editing this manuscript.

Compliance with ethical standards

Disclosures

Victor Vakayil, Brent Bauman, Keaton Joppru, Reema Mallick, Christopher Tignanelli, John Connett, Sayeed Ikramuddin, and James V. Harmon Jr. have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2018_6366_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 KB)

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Authors and Affiliations

  1. 1.Department of SurgeryUniversity of MinnesotaMinneapolisUSA
  2. 2.School of Public Health, University of MinnesotaMinneapolisUSA
  3. 3.University of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Department of SurgeryUniversity of Alabama-BirminghamBirminghamUSA
  5. 5.Division of BiostatisticsSchool of Public Health, University of MinnesotaMinneapolisUSA
  6. 6.Critical Care and Acute Care SurgeryUniversity of MinnesotaMinneapolisUSA

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