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Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value

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Abstract

Background and aims

Clear patient selection criteria and indications for laparoscopic repair of perforated duodenal ulcers are necessary. The aims of our study are to report the early outcome results after operation and to define the predictive values of risk factors influencing conversion rate and genesis of suture leakage.

Patients/methods

Sixty nonrandomly selected patients operated on laparoscopically in a tertiary care academic center between October 1996 and May 2004 for perforated duodenal ulcers were retrospectively analyzed. The primary outcome measures included the duration of symptoms, shock, underlying medical illness, ulcer size, age, Boey score, and the collective predictive value of these variables for conversion and suture leakage rates.

Results

Laparoscopic repair was completed in 46 patients (76.7%). Fourteen patients (23.3%) underwent conversion to open repair. Eight patients (13.3%) had postoperative complications. Suture leakage was confirmed in four patients (6.7%). Hospital stay was 7.8±5.3 days. There was no mortality. Patients with an ulcer perforation size of >8 mm had a significantly increased risk for conversion to open repair (p<0.05): positive predictive value (PPV) 75%, sensitivity 27%, specificity 98%, and negative predictive value (NPV) 85%. The significance of ulcer perforation size was confirmed by a stepwise logistic regression test (p=0.0201). All patients who developed suture leakage had acute symptoms for >9 h preoperatively (p<0.001): PPV 31%, specificity 84%, sensitivity 100%, and NPV 100%. Conversions happened with surgeons whose previous experience involved 1.8±2.3 cases compared to 3.9±2.9 cases in successful laparoscopic repair (p=0.039, t test).

Conclusions

Ulcer perforation size of >8 mm is a significant risk factor influencing the conversion rate. An increase in the suture leakage rate is predicted by delayed presentation of >9 h.

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Acknowledgements

Special thanks to Dr. Gerald M. Funk (Department of Mathematics and Statistics, Loyola University, Chicago, USA) for proofreading our paper and Dr. Juozas Kurtinaitis (Department of Cancer Register, Institute of Oncology, Vilnius University, Lithuania) for consulting on statistics.

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Authors and Affiliations

  1. Clinic of General and Plastic Surgery, Orthopaedics and Traumatology, Vilnius University, Siltnamiu str. 29, 04130, Vilnius, Lithuania

    Raimundas Lunevicius & Matas Morkevicius

  2. General Surgery Center, 2nd Abdominal Surgery Department, Vilnius University Emergency Hospital, Siltnamių str. 29, 04130, Vilnius, Lithuania

    Raimundas Lunevicius

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  1. Raimundas Lunevicius
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  2. Matas Morkevicius
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Correspondence to Raimundas Lunevicius.

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Lunevicius, R., Morkevicius, M. Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value. Langenbecks Arch Surg 390, 413–420 (2005). https://doi.org/10.1007/s00423-005-0569-0

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  • DOI: https://doi.org/10.1007/s00423-005-0569-0

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