Laparoscopic Repair for Perforated Peptic Ulcer: A Retrospective Study

• Published in: World journal of surgery Vol. 41; no. 4; pp. 948 - 953
• Main Authors: Vărcuş, Flore, Beuran, Mircea, Lica, Ioan, Turculet, Claudiu, Cotarlet, Adrian Valentin, Georgescu, Stefan, Vintila, Dan, Sabău, Dan, Sabau, Alexandru, Ciuce, Constantin, Bintintan, Vasile, Georgescu, Eugen, Popescu, Razvan, Tarta, Cristi, Surlin, Valeriu
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Cardiac Surgery; Conversion to Open Surgery - statistics & numerical data; Duodenal Fistula; Female; General Surgery; Humans; Laparoscopic Approach; Laparoscopy; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Scientific Report; Peptic Ulcer Perforation - surgery; Perforated Peptic Ulcer; Peritoneal Lavage; Postoperative Complications - epidemiology; Retrospective Studies; Romania - epidemiology; Surgery; Taylor Method; Thoracic Surgery; Vascular Surgery; Young Adult; Peritoneal Lavage; Perforated Peptic Ulcer; Taylor Method; Laparoscopic Approach; Duodenal Fistula
• DOI: 10.1007/s00268-016-3821-6
• EISSN: 1432-2323
• ISSN: 0364-2313

Backgrounds
The incidence of patients presenting with perforated peptic ulcers (PPU) has decreased during the last decades. At the same time, a laparoscopic approach to this condition has been adopted by increased number of surgeons. The aim of this study was to evaluate the early postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in eight Romanian surgical centers with extensive experience in laparoscopic surgery.
Methods
Between 2009 and 2013, 297 patients with perforated peptic ulcer were operated in the eight centers participating in this retrospective study. The patients’ charts were reviewed for demographics, surgical procedure, complications and short-term outcomes.
Results
Boey score of 0 was found in 122 patients (41.1%), Boey 1 in 169 (56.9%), Boey 3 in 6 (2.0%). For 145 (48.8%) patients, primary suture repair was performed, in 146 (49.2%) primary suture repair with omentopexy. There were 6 (2.0%) conversions to open surgery. The operative time was between 25 and 120 min, with a mean of 68 min. Two (0.7%) deaths were noted. Mean hospital stay was 5.5 days, ranges 3–25 days. Postoperative complications included: 7 (2.4%) superficial surgical site infections, 5 (1.6%) cardiovascular, 3 (1.0%) pulmonary, 2 (0.7%) duodenal leakages, 3 (1.0%) deep space infections and 1 (0.3%) upper digestive hemorrhage.
Conclusions
This study shows that the laparoscopic approach for PPU is feasible; the procedure is safe, with no increased risk of duodenal fistulae or residual intraperitoneal abscesses. We now consider the laparoscopic approach for PPU as the “gold standard” in patients with Boey score 0 or 1.