Laparoscopic repair of perforated peptic ulcer – routine procedure or targeted patient selection?
Authors:
L. Tulinský 1,2; M. Mitták 1,2; J. Hrubovčák 1,2; M. Kepičová 1,2; P. Ihnát 1,2; L. Martínek 1,2
Authors‘ workplace:
Chirurgická klinika Fakultní nemocnice Ostrava
1; Katedra chirurgických studií, Lékařská fakulta, Ostravská univerzita
2
Published in:
Rozhl. Chir., 2022, roč. 101, č. 7, s. 326-331.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2022.101.7.326–331
Overview
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.
Keywords:
mortality – open repair – perforated peptic ulcer – laparoscopic repair – Boey score
Sources
1. Lin KJ, García Rodríguez LA, Hernández- Díaz S. Systematic review of peptic ulcer disease incidence rates: do studies without validation provide reliable estimates? Pharmacoepidemiology and Drug Safety 2011 May 27;20(7):718–728. doi:10.1002/pds.2153.
2. Dítě P. Vředová nemoc žaludku a dvanáctníku, současné léčebné trendy. Interní Med. 2006; 8(5):231–234.
3. Wakayama T, Ishizaki Y, Mitsusada M, et al. Risk factors influencing the short-term results of gastroduodenal perforation. Surgery Today 1994 Aug;24(8):681–687. doi:10.1007/BF01636772.
4. Christensen S, Riis A, Nørgaard M, et al. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatrics 2007 Apr 17;7(1). doi:10.1186/1471-2318-7-8.
5. Noguiera C, Silva AS, Santos JN, et al. Perforated peptic ulcer: Main factors of morbidity and mortality. World Journal of Surgery 2003 Jul 1;27(7):782–787. doi: 10.1007/s00268-003-6645-0.
6. Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013;21(1):25. doi:10.1186/1757-7241-21-25.
7. Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: Clinical presentation, surgical outcomes, and the accuracy of the boey scoring system in predicting postoperative morbidity and mortality. World Journal of Surgery 2008 Oct 29;33(1):80–85. doi:10.1007/s00268- 008-9796-1.
8. Boey J, Choi SK, Alagaratnam TT, et al. A prospective validation of predictive factors. Annals of Surgery 1987 Jan;205(1):22–32. doi:10.1097/00000658- 198701000-00005.
9. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications. Annals of Surgery 2009 Aug;250(2):187–196. doi:10.1097/ SLA.0b013e3181b13ca2.
10. Nathanson LK, Easter DW, Cuschieri A. Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer. Surgical Endoscopy 1990 Dec;4(4):232–233. doi:10.1007/BF00316801.
11. Wright GP, Davis AT, Koehler TJ, et al. Cost-efficiency and outcomes in the treatment of perforated peptic ulcer disease: Laparoscopic versus open approach. Surgery 2014 Oct;156(4):1003– 1008. doi:10.1016/j.surg.2014.06.047.
12. Davenport DL, Ueland WR, Kumar S, et al. A comparison of short-term outcomes between laparoscopic and open emergent repair of perforated peptic ulcers. Surgical Endoscopy 2018 Jul 11;33(3):764–772. doi:10.1007/s00464-018-6341-7.
13. Starý L, Vysloužil K, Klementa I, et al. Laparoskopické ošetření perforovaného vředu gastroduodena. Miniinvazívna chirurgia 2008;12(1):5–8.
14. Jayaraman SS, Allen R, Feather C, et al. Outcomes of laparoscopic vs open repair of perforated peptic ulcers: An ACSNSQIP study. Journal of Surgical Research 2021 Sep;265:13–20. doi:10.1016/j. jss.2021.02.030.
15. Pereira A, Santos Sousa H, Gonçalves D, et al. Surgery for perforated peptic ulcer: Is laparoscopy a new paradigm? Minimally Invasive Surgery 2021 May 12;2021:1–6. doi:10.1155/2021/8828091.
16. Fransvea P, Costa G, Lepre L, et al. Laparoscopic repair of perforated peptic ulcer in the elderly: An interim analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2020 Jul 14;31(1):2–7. doi:10.1097/ SLE.0000000000000826.
17. Pelloni M, Afonso-Luís N, Marchena-Gomez J, et al. Comparative study of postoperative complications after open and laparoscopic surgery of the perforated peptic ulcer: Advantages of the laparoscopic approach. Asian Journal of Surgery 2022 Apr;45(4):1007–1013. doi:10.1016/j. asjsur.2021.08.059.
18. Quah GS, Eslick GD, Cox MR. Laparoscopic repair for perforated peptic ulcer disease has better outcomes than open repair. Journal of Gastrointestinal Surgery 2018 Nov 21;23(3):618–625. doi:10.1007/ s11605-018-4047-8.
19. Varcus F, Paun I, Duta C, et al. Laparoscopic repair of perforated peptic ulcer. Minerva Surgery 2018 Apr;73(2). doi:10.23736/s0026-4733.18.07603-4.
20. Chung KT, Shelat VG. Perforated peptic ulcer – an update. World Journal of Gastrointestinal Surgery 2017;9(1):1. doi:10.4240/wjgs.v9.i1.1.
21. Menekse E, Kocer B, Topcu R, et al. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World Journal of Emergency Surgery 2015 Feb 21;10(1). doi:10.1186/s13017- 015-0008-7.
22. Satinský I. Perforovaný peptický vřed – předoperační rizika, pooperační morbidita a mortalita, profylaxe v intenzivní péči a doporučení. Anesteziologie a intenzivní medicína 2012,
23.5:259–263. 23. Lunevicius R, Morkevicius M. Systematic review comparing laparoscopic and open repair for perforated peptic ulcer. British Journal of Surgery 2005 Sep 20;92(10):1195–1207. doi:10.1002/ bjs.5155.
24. Zhou C, Wang W, Wang J, et al. An updated meta-analysis of laparoscopic versus open repair for perforated peptic ulcer. Scientific Reports. 2015 Sep 9;5(1). doi:10.1038/srep13976.
25. Wilhelmsen M, Møller MH, Rosenstock S. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort. British Journal of Surgery 2015 Jan 21;102(4):382–387. doi:10.1002/bjs.9753.
26. Lee FYJ, Leung KL, Lai PBS, et al. Selection of patients for laparoscopic repair of perforated peptic ulcer. British Journal of Surgery 2001 Jan;88(1):133–136. doi:10.1046/j.1365-2168.2001.01642.x.
27. Siu WT, Leong HT, Law BKB, et al. Laparoscopic repair for perforated peptic ulcer. Annals of Surgery 2002 Mar;235(3):313– 319. doi:10.1097/00000658-200203000- 00001.
28. Lau W-Y, Leung K-L, Kwong K-H, et al. A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Annals of Surgery 1996 Aug;224(2):131– 138. doi:10.1097/00000658-199608000- 00004.
29. Siu WT, Chau CH, Law BKB, et al. Routine use of laparoscopic repair for perforated peptic ulcer. British Journal of Surgery 2004 Feb 20;91(4):481–484. doi:10.1002/ bjs.4452.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2022 Issue 7
Most read in this issue
- Diagnosis and treatment of surgical skin and soft tissue infections – current status
- Giant aggressive intra-abdominal desmoid-type fibromatosis – case report
- Laparoscopic repair of perforated peptic ulcer – routine procedure or targeted patient selection?
- Benign stenosis of common bile duct after Roux Y gastrectomy