Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study
Abstract Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minim...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12893-018-0413-4 |
| _version_ | 1828859403971854336 |
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| author | Antonino Mirabella Tiziana Fiorentini Roberta Tutino Nicolò Falco Tommaso Fontana Paolino De Marco Eliana Gulotta Leonardo Gulotta Leo Licari Giuseppe Salamone Irene Melfa Gregorio Scerrino Massimo Lupo Armando Speciale Gianfranco Cocorullo |
| author_facet | Antonino Mirabella Tiziana Fiorentini Roberta Tutino Nicolò Falco Tommaso Fontana Paolino De Marco Eliana Gulotta Leonardo Gulotta Leo Licari Giuseppe Salamone Irene Melfa Gregorio Scerrino Massimo Lupo Armando Speciale Gianfranco Cocorullo |
| author_sort | Antonino Mirabella |
| collection | DOAJ |
| description | Abstract Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient’s age, surgical technique and Boey’s score were evaluated. Results The relationship between laparoscopic or open treatment and the Boey’s score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients’ Boey’s score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey’s score group and in the 10.7% of the high Boey’s score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey’s score. In our series laparoscopy was not used in high risk Boey’s score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials. |
| first_indexed | 2024-12-13T02:17:58Z |
| format | Article |
| id | doaj.art-34a08798f5474d469fbd449dea3846c4 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-13T02:17:58Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-34a08798f5474d469fbd449dea3846c42022-12-22T00:02:50ZengBMCBMC Surgery1471-24822018-09-011811610.1186/s12893-018-0413-4Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter studyAntonino Mirabella0Tiziana Fiorentini1Roberta Tutino2Nicolò Falco3Tommaso Fontana4Paolino De Marco5Eliana Gulotta6Leonardo Gulotta7Leo Licari8Giuseppe Salamone9Irene Melfa10Gregorio Scerrino11Massimo Lupo12Armando Speciale13Gianfranco Cocorullo14O.U. of Emergency and General Surgery of “Villa Sofia” HospitalO.U. of Emergency and General Surgery of “Cervello” HospitalDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoO.U. of Emergency and General Surgery of “Villa Sofia” HospitalO.U. of Emergency and General Surgery of “Cervello” HospitalDepartment of Surgical, Oncological and Stomatological Disciplines, University of PalermoAbstract Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient’s age, surgical technique and Boey’s score were evaluated. Results The relationship between laparoscopic or open treatment and the Boey’s score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients’ Boey’s score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey’s score group and in the 10.7% of the high Boey’s score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey’s score. In our series laparoscopy was not used in high risk Boey’s score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.http://link.springer.com/article/10.1186/s12893-018-0413-4Peptic ulcer perforationLaparoscopyStomachAged |
| spellingShingle | Antonino Mirabella Tiziana Fiorentini Roberta Tutino Nicolò Falco Tommaso Fontana Paolino De Marco Eliana Gulotta Leonardo Gulotta Leo Licari Giuseppe Salamone Irene Melfa Gregorio Scerrino Massimo Lupo Armando Speciale Gianfranco Cocorullo Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study BMC Surgery Peptic ulcer perforation Laparoscopy Stomach Aged |
| title | Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study |
| title_full | Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study |
| title_fullStr | Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study |
| title_full_unstemmed | Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study |
| title_short | Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study |
| title_sort | laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers a retrospective multicenter study |
| topic | Peptic ulcer perforation Laparoscopy Stomach Aged |
| url | http://link.springer.com/article/10.1186/s12893-018-0413-4 |
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