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Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study
Gianrocco Manco1, Stefania Caramaschi2, Giovanni Rolando1
1Department of Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy.
Insights
Laparoscopic repair of perforated peptic ulcers offers advantages with acceptable morbidity and mortality. This approach, particularly for high-risk patients identified by the Boey Score, should be considered the primary surgical method.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Perforated peptic ulcer (PPU) is a severe complication of peptic ulcer disease, associated with significant morbidity and mortality.
- While peptic ulcer disease incidence has declined, PPU requiring emergency surgery remains prevalent.
- Laparoscopic management for PPU is increasingly adopted but not universally standard.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a primary laparoscopic approach for treating perforated peptic ulcers.
- To assess the feasibility and safety of laparoscopic repair in a cohort of patients with PPU.
Main Methods:
- A retrospective analysis of 42 patients who underwent surgical treatment for perforated peptic ulcer between January 2012 and December 2016.
- All patients were treated using a three-port laparoscopic technique for perforation repair and omental patching.
- The Boey scoring system was utilized to predict patient prognosis.
Main Results:
- Laparoscopic repair was successfully completed in all patients without conversion to open surgery.
- Postoperative complications included duodenal leakage (7.1%), deep space infections (4.7%), and mortality (9.5%).
- Mortality was associated with patients classified as American Society of Anesthesiologists Classification >III and Boey Score 3, primarily due to multisystem organ failure.
Conclusions:
- A primary laparoscopic approach for perforated peptic ulcer offers postoperative benefits with manageable morbidity and mortality rates.
- Outcomes, particularly mortality, are strongly correlated with higher Boey Scores.
- Laparoscopic repair should be considered the initial surgical strategy for perforated peptic ulcers.
Background:
Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers.
Methods:
Clinical and surgical data on 42 patients underwent surgical treatment for perforated peptic ulcer from January 2012 to December 2016 were collected. Laparoscopic repair of the perforation with a three-port technique was made in all cases. The Boey scoring system was used to predict the prognosis.
Results:
All patients underwent suture-closure of the ulcer, and omental patch through laparoscopy without conversion to open surgery. Duodenal leakages occurred in 3 patients (7.1%), then treated with a conservative approach and resolved on the 10th postoperative day. Two patients (4.7%) had deep space infections in the first week after surgery, therefore subdiaphragmatic and pelvic abscess were drained by ultrasound guidance. Four patients (9.5%) died up to 30-day post-surgery due to progression of multisystem organ failure in absence of leakages or infections. All these patients were American Society of Anesthesiologists Classification >III and Boey Score 3.
Conclusions:
Our data show that a primary laparoscopic approach in patients with peptic ulcer perforation is associated with postoperative advantages and acceptable rates of morbidity and mortality, essentially related to high Boey Score. Therefore, we suggest that the surgical repair of PPU could be always started laparoscopically.
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