Open vs laparoscopic repair of perforated peptic ulcer.
Publication/Presentation Date
7-1-1999
Abstract
BACKGROUND: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer.
METHODS: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996.
RESULTS: The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly.
CONCLUSION: The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.
Volume
13
Issue
7
First Page
679
Last Page
682
ISSN
0930-2794
Published In/Presented At
Bergamaschi, R., Mårvik, R., Johnsen, G., Thoresen, J. E., Ystgaard, B., & Myrvold, H. E. (1999). Open vs laparoscopic repair of perforated peptic ulcer. Surgical endoscopy, 13(7), 679–682. https://doi.org/10.1007/s004649901072
Disciplines
Medicine and Health Sciences
PubMedID
10384074
Department(s)
Department of Surgery
Document Type
Article