Laparoscopic suture closure of perforated peptic ulcer

Background: Laparoscopic vs open suture in the surgical treatment of perforated peptic ulcer were compared in a retrospective study. Methods: The outcome of 10 patients having the laparoscopic procedure was compared with the outcome of 17 patients treated with suture via laparotomy during the same time period. Results: The mortality rate and the complication rate were comparable. The laparoscopic procedure was more time consuming; hospital stay did not differ. Conclusions: The results indicate that surgery for perforated peptic ulcer can be performed with the laparoscopic technique with an outcome comparable to open surgery. No obvious advantages to the patient were noted with the laparoscopic method.This study has been presented as an abstract at the EAES meeting in Madrid, September 1994     

Laparoscopic suture closure of perforated duodenal peptic ulcer

The aim of this study was to assess the outcome of a continuous series of 30 patients with perforated duodenal peptic ulcers treated by a laparoscopic approach. Between January 1996 and December 1998, 30 patients (24 males, 6 females) with a mean age of 69.2 years were operated on with a laparoscopic approach. Laparoscopic treatment included peritoneal lavage, suture of the perforation, and omental patching in 24 cases. A conversion to laparotomy was necessary in five patients (16.6%). Mean operative time was 92 minutes (range: 58-114) and mean hospital stay was 6 days (range: 4-16). Mortality and morbidity rates were 6.6% (n = 2) and 16.6% (n = 5). With a median follow-up of 12 months, 96% of the patients were in good condition; one patient had recurrent duodenal ulceration. The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates.     

Laparoscopic repair of iatrogenic endoscopic perforated peptic ulcer

Iatrogenic perforation is an uncommon but inevitable complication of endoscopy. Laparotomy has been the standard treatment for pyloroduodenal perforations caused by endoscopy. Laparoscopic repair is a well-documented treatment modality for spontaneously perforated peptic ulcer. We report our successful laparoscopic suture repair of perforations sustained during upper gastrointestinal endoscopy in two high-risk elderly patients.     

Laparoscopic and conventional closure of perforated peptic ulcer

Surgical Endoscopy -     

Laparoscopic and conventional closure of perforated peptic ulcer

Background: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. Methods: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. Results: Consumption of analgesics was lower in the laparoscopic group. Conclusions: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.     

Laparoscopic repair of perforated peptic ulcer: a meta-analysis

Background Laparoscopic repair of perforated peptic ulcer has been gaining popularity in recent years, but few data exist to support the superiority of the laparoscopic approach over open repair. The objective of the current study was to compare the safety and efficacy of open and laparoscopic repair of perforated peptic ulcer in an evidence-based approach using meta-analytical techniques.Methods A search of electronic databases, including MEDLINE and EMBASE, was conducted to identify relevant articles published between January 1990 and December 2002. Only studies in the English language comparing the outcomes of laparoscopic and open repair of perforated peptic ulcer were recruited. All reports were critically appraised with respect to their methodology and outcome. Data from all included studies were extracted using standardized data extraction forms developed a priori. Both qualitative and quantitative statistical analyses were performed. The effect size of outcome parameters was estimated by odds ratio where feasible and appropriate.Results A total of 13 publications comprising 658 patients met the inclusion criteria. The overall success rate of laparoscopic repair was 84.7% (n = 249). Postoperative pain was lower after laparoscopic repair than after open repair, supported by a significant reduction in postoperative analgesic requirement after laparoscopic repair. Meta-analyses demonstrated a significant reduction in the wound infection rate after laparoscopic repair, as compared with open repair, but a significantly higher reoperation rate was observed after laparoscopic repair.Conclusions Evidence suggests that laparoscopic repair of perforated peptic ulcer confers superior short-term benefits in terms of postoperative pain and wound morbidity. This approach is as safe and effective as open repair. Laparoscopic Graham–Steele patch repair of perforated duodenal or justapyloric ulcer is beneficial for patients without Boeys risk factors.     

Laparoscopic repair of perforated peptic ulcer: single-center results

Background

Perforated peptic ulcer (PPU), the most common indication for emergency gastric surgery, is associated with high morbidity and mortality rates. Outcomes might be improved by performing this procedure laparoscopically, but no consensus exists on whether the benefits of laparoscopic repair (LR) of PPU outweigh the disadvantages.

Methods

From January 2002 to December 2012, 111 patients underwent surgery for perforated ulcer. A “laparoscopy-first” policy was attempted and then applied for 56 patients. The exclusion criteria for LR ruled out patients who had shock at admission, severe cardiorespiratory comorbidities, or a history of supramesocolic surgery. The aim of this study was a retrospective analysis of the 56 patients treated laparoscopically.

Results

The patient distribution was 30 men and 26 women, who had a mean age of 59 years (range 19–95 years). The mean ulcer size was 10 mm, and the Mannheim peritonitis index (MPI) was 21. LR was performed for 39 (69.6 %) of the 56 patients and included peritoneal lavage, suturing of the perforation, and omental patching. Conversion to laparotomy was necessary in 17 cases (30.4 %). The “conversion group” showed significant differences in ulcer size (larger ulcers: 1.9 vs 0.7 mm; p < 0.01), ulcer-site topography (higher incidence of posterior ulcers: 5 vs 0; p < 0.01), and MPI score (higher score: 24 vs 20; p < 0.05). The LR group had a mean operating time of 86 min (range 50–125 min), an in-hospital morbidity rate of 7.6 %, a mortality rate of 2.5 %, and a mean hospital stay of 6.7 days (range 5–12 days). None of these patients required reintervention.

Conclusions

The results showed that LR for PPU is feasible with acceptable mortality and morbidity rates. Skill in laparoscopic abdominal emergencies is required. Perforations 1.5 cm or larger, posterior duodenal ulcers, and an MPI higher than 25 should be considered the main risk factors for conversion.     

Laparoscopic omental patch repair for perforated peptic ulcer.

OBJECTIVE: The authors' initial experience with laparoscopic omental patch repair for perforated peptic ulcer is documented. Its results are compared with those of other procedures and follow-up study is reviewed. SUMMARY BACKGROUND DATA: Since the advent of H2-antagonists, the usefulness of simple closure of a perforated peptic ulcer is increasing, and improvements in laparoscopic surgery have made possible minimally invasive surgery for perforated ulcer. METHODS: From December 1992 to February 1994, laparoscopic omental patch repair followed by use of H2-antagonists was performed successfully in 11 patients. Fifty-five patients underwent other surgical procedures for perforated peptic ulcers (conventional open omental patch: 4, selective vagotomy in combination with antrectomy: 24, distal gastrectomy: 27). RESULTS: The average operation time was 135 minutes. Administration of postoperative pain medication was reduced remarkably (0.9 times per patient), and all patients recovered rapidly. No serious postoperative complications were recorded. After a mean period of 11 months, the postoperative evaluation was satisfactory for all patients, and no ulcer recurrence was found. CONCLUSIONS: In perforated peptic ulcer disease, laparoscopic omental patch repair offers a number of advantages. Because no upper abdominal incision is made, there is decreased postoperative pain, and the patient rapidly recovers with fewer and less severe complications. Although the procedure requires a surgeon with particular expertise in endoscopic suturing technique, surgeons familiar with laparoscopic cholecystectomy can readily perform it after some practice. The authors' preliminary experience suggests that this is a minimally invasive procedure for perforated peptic ulcer that offers an attractive alternative to open surgery.     

Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial

OBJECTIVE: To compare the results of open versus laparoscopic repair for perforated peptic ulcers. SUMMARY BACKGROUND DATA: Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. METHODS: From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gastrografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complications and deaths, and the date of return to normal daily activities. RESULTS: Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine conversions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intraabdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair.     

Laparoscopic and open operation in patients with perforated peptic ulcer.

OBJECTIVES: To compare the results of laparoscopic and open operations in patients with perforated peptic ulcer. DESIGN: Retrospective analysis. SETTING: Central hospital, Norway. SUBJECTS: 74 patients (36 men, 38 women, median age 69.5 years (18-86)) admitted with perforated peptic ulcers from November 1991-May 1996. INTERVENTIONS: Suture of the ulcer, patching with the greater omentum and lavage, in 49 by open operation and 25 laparoscopically. MAIN OUTCOME MEASURES: Duration of postoperative hospital stay, operating time, number of doses of analgesic, postoperative body temperature, complications, and mortality. RESULTS: There was a significant difference (p = 0.0001) in median operating time: 100 minutes (range 48-160) in the laparoscopic group and 50 minutes (range 20-160) in the open group. The median hospital stay was 8 days in both groups: range 3-23 days in the laparoscopic group and 2-28 days in the open group. There were no significant differences between the two groups with regard to median number of doses of analgesic, median body temperature, complications or mortality. CONCLUSION: Laparoscopic operation for perforated peptic ulcer can be considered as safe as open operation.