Skip to main content

Advertisement

SpringerLink
Log in

The Selective Use of Laparoscopic Repair is Safe in High-Risk Patients Suffering from Perforated Peptic Ulcer

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The use of laparoscopic repair for perforated peptic ulcer (PPU) was shown to be safe and recommended in low-risk patients. However, whether the approach is safe to apply to high-risk patients is uncertain.

Study design

This was a retrospective study of all patients with PPU admitted between January 2002 and December 2012. The laparoscopy-first approach (LFA) was adopted as a routine for all patients. The outcomes of LFA for PPU were reviewed and assessed to determine if the approach was safe in high-risk patients.

Results

Three hundred and seventy three patients that suffered from PPU were included into the study and 50.9 % received laparoscopic repair. There was a significant increase in the number of operations performed yearly by the LFA (P < 0.001). 25.2 % of the patients had a Boey score of ≥2. High-risk patients that received LFA suffered from larger ulcers (P < 0.001) with more severe contamination (P = 0.006) that required conversion (P = 0.002) when compared to the low-risk patients. When compared to open surgery, more high-risk patients in the open group had ASA grade ≥3 (P = 0.007) and suffered from mortality (P = 0.001). The only significant predictor to mortality in high-risk patients was ASA grade ≥3 (P = 0.014).

Conclusions

The adoption of LFA in patients suffering from PPU was associated with acceptable rates of mortality and morbidity. The approach could also be selectively adopted in patients with Boey score ≥2 provided their ASA grading is low and hemodynamically stable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC (2011) Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 84:102–113

    Article  PubMed  Google Scholar 

  2. Ford AC, Delaney BC, Forman D, Moayyedi P (2006) Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev 2:CD003840

    PubMed  Google Scholar 

  3. Ng EK, Lam YH, Sung JJ et al (2000) Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg 231:153–158

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Bertleff MJ, Lange JF (2010) Perforated peptic ulcer disease: a review of history and treatment. Dig Surg 27:161–169

    Article  PubMed  Google Scholar 

  5. Lee FY, Leung KL, Lai PB, Lau JW (2001) Selection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg 88:133–136

    Article  CAS  PubMed  Google Scholar 

  6. Crofts TJ, Park KG, Steele RJ, Chung SS, Li AK (1989) A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med 320:970–973

    Article  CAS  PubMed  Google Scholar 

  7. Lau WY, Leung KL, Kwong KH, Davey IC, Robertson C, Dawson JJ et al (1996) A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 224:131–138

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Bertleff MJ, Halm JA, Bemelman WA et al (2009) Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg 33:1368–1373. doi:10.1007/s00268-009-0054-y

    Article  PubMed Central  PubMed  Google Scholar 

  9. Siu WT, Leong HT, Law BK et al (2002) Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg 235:313–319

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sanabria A, Villegas MI, Morales Uribe CH (2013) Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev 2:CD004778

    PubMed  Google Scholar 

  11. Siu WT, Leong HT, Li MK (1997) Single stitch laparoscopic omental patch repair of perforated peptic ulcer. J R Coll Surg Edinb 42:92–94

    CAS  PubMed  Google Scholar 

  12. Agresta F, Ansaloni L, Baiocchi GL et al (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26:2134–2164

    Article  PubMed  Google Scholar 

  13. Katkhouda N, Mavor E, Mason RJ, Campos GM, Soroushyari A, Berne TV (1999) Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg 134:845–848

    Article  CAS  PubMed  Google Scholar 

  14. Lunevicius R, Morkevicius M (2005) Comparison of laparoscopic versus open repair for perforated duodenal ulcers. Surg Endosc 19:1565–1571

    Article  CAS  PubMed  Google Scholar 

  15. Bertleff MJ, Lange JF (2010) Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature. Surg Endosc. 24:1231–1239

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K (2011) Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers. World J Surg 35:2485–2492. doi:10.1007/s00268-011-1252-y

    Article  PubMed  Google Scholar 

  17. Kim JM, Jeong SH, Lee YJ et al (2012) Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer 12:26–35

    Article  PubMed Central  PubMed  Google Scholar 

  18. Boey J, Wong J, Ong GB (1982) A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg 195:265–269

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Møller MH, Adamsen S, Thomsen RW, Møller AM (2010) Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol 45:785–805

    Article  PubMed  Google Scholar 

  20. Møller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW (2012) The peptic ulcer perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand 56:655–662

    Article  PubMed  Google Scholar 

  21. Cheng M, Li WH, Cheung MT (2012) Early outcome after emergency gastrectomy for complicated peptic ulcer disease. Hong Kong Med J 18:291–298

    PubMed  Google Scholar 

  22. Vashist YK, Yekebas EF, Gebauer F et al (2012) Management of the difficult duodenal stump in penetrating duodenal ulcer disease: a comparative analysis of duodenojejunostomy with “classical” stump closure (Nissen-Bsteh). Langenbecks Arch Surg 397:1243–1249

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

All authors do not have any disclosures to make. AY Teoh had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study was not supported by any research Grant.

Author information

Authors and Affiliations

  1. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, New Territories, Hong Kong

    Anthony Yuen Bun Teoh, Philip Wai Yan Chiu, Amy Siu Yan Kok, Simon Kin Hung Wong & Enders Kwok Wai Ng

Authors
  1. Anthony Yuen Bun Teoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip Wai Yan Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy Siu Yan Kok
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simon Kin Hung Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enders Kwok Wai Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony Yuen Bun Teoh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Teoh, A.Y.B., Chiu, P.W.Y., Kok, A.S.Y. et al. The Selective Use of Laparoscopic Repair is Safe in High-Risk Patients Suffering from Perforated Peptic Ulcer. World J Surg 39, 740–745 (2015). https://doi.org/10.1007/s00268-014-2851-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2851-1

Keywords

Search

Navigation