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Laparoscopic repair of perforated peptic ulcer - routine procedure or targeted patient selection?
Insights
Laparoscopic repair of peptic ulcer perforation may be suitable for low-risk patients, though it showed higher complication rates. The Boey score accurately predicts mortality risk for surgical approach selection.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Outcomes Research
Background:
- Peptic ulcer perforation is a serious gastrointestinal complication with high mortality.
- Surgical repair via laparoscopy or laparotomy is the standard treatment.
- Accurate risk assessment is crucial for selecting the optimal surgical approach.
Purpose of the Study:
- To compare short-term outcomes of laparoscopic versus open repair for acute peptic ulcer perforation.
- To evaluate the predictive accuracy of the Boey scoring system in the Czech population for surgical decision-making.
Main Methods:
- Retrospective analysis of 60 patients undergoing laparoscopic or open repair of perforated peptic ulcer (2017-2021).
- Data collection on postoperative morbidity, complication rates (mild and severe), and mortality.
- Assessment of the correlation between Boey score and patient outcomes.
Main Results:
- Laparoscopic repair was performed in 43.3%, open repair in 56.7% of patients.
- Overall postoperative morbidity was 70.0%, with higher rates of mild and severe complications in the laparoscopic group (26.9% vs 20.6% and 19.2% vs 14.7%, respectively).
- Despite higher complication rates, laparoscopy had lower mortality (15.4% vs 41.2%), aligning with the Boey score's risk prediction.
Conclusions:
- Laparoscopic repair is a viable option for low-risk peptic ulcer perforation patients.
- The Boey score accurately predicts mortality risk, guiding the choice between laparoscopic and open surgical approaches.
- While laparoscopy may have increased complication incidence, open repair is associated with higher mortality, particularly in patients with worse initial clinical status.
Introduction:
Peptic ulcer is one of the most common diseases of the proximal gastrointestinal tract. Its complications are relatively common, the most serious one being peptic ulcer perforation with the incidence of about 10 cases per 100,000 population per year and the mortality rate of 10-40%. Surgical suture via laparoscopy or laparotomy is the only treatment option. The aim of the study was to compare the short-term results of laparoscopic and open repair of acute peptic ulcer perforation and evaluate the accuracy of the Boey scoring system in the Czech population.
Methods:
Retrospective study conducted at the surgical department of the University Hospital Ostrava. The patients underwent laparoscopic or open repair of perforated peptic ulcer in 2017-2021.
Results:
The study included 60 patients; laparoscopic repair was performed in 43.3% of the patients, and open repair in 56.7%. Postoperative morbidity was 70.0%, mild complications were reported in 23.3% of the patients, and severe complications in 16.7%. Patients undergoing the laparoscopic repair showed a higher incidence of mild as well as severe complications (26.9% vs 20.6% and 19.2% vs 14.7%) but also a higher incidence of an uncomplicated postoperative course. Overall postoperative mortality was 30.0% (laparoscopy 15.4%, laparotomy 41.2%). The study results confirmed the estimated baseline risk of mortality based on the Boey score.
Conclusion:
Laparoscopic repair may be the procedure of choice for patients with no or low risk factors. Patients undergoing laparoscopy showed a higher incidence of mild and severe complications. The higher mortality of patients after open repair is related to their worse initial clinical condition. Preoperative determination of mortality risk using the Boey score is accurate and appropriate in terms of choosing the surgical approach.
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