Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique
Background/Objective: The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution. Methods: This is a retrospective review of a prospectively collected database of patients who underwent emergenc...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-03-01
|
| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S101595841630210X |
| _version_ | 1828275755207884800 |
|---|---|
| author | Sze Li Siow Hans Alexander Mahendran Chee Ming Wong Mark Hardin Tien Loong Luk |
| author_facet | Sze Li Siow Hans Alexander Mahendran Chee Ming Wong Mark Hardin Tien Loong Luk |
| author_sort | Sze Li Siow |
| collection | DOAJ |
| description | Background/Objective: The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution.
Methods: This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014.
Results: A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n = 63, 48.1% vs. open repair, n = 68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p = 0.434), gender (p = 0.305), body mass index (p = 0.180), and presence of comorbidities (p = 0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p = 0.769), Boey scores 0/1 (p = 0.311), Mannheim Peritonitis Index > 27 (p = 0.528), shock on admission (p < 0.99), and the duration of symptoms > 24 hours (p = 0.857). There was no significant difference in the operating time between the two groups (p = 0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p = 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p = 0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p = 0.008) and lower pain scores in the immediate postoperative period (p < 0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99).
Conclusion: Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group. |
| first_indexed | 2024-04-13T06:50:16Z |
| format | Article |
| id | doaj.art-4c038c0958f643319ae6273d4bbc2d98 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-04-13T06:50:16Z |
| publishDate | 2018-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-4c038c0958f643319ae6273d4bbc2d982022-12-22T02:57:25ZengElsevierAsian Journal of Surgery1015-95842018-03-0141213614210.1016/j.asjsur.2016.11.004Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized techniqueSze Li Siow0Hans Alexander Mahendran1Chee Ming Wong2Mark Hardin3Tien Loong Luk4Department of Surgery, Sarawak General Hospital, Kuching, MalaysiaDepartment of Surgery, Sarawak General Hospital, Kuching, MalaysiaDepartment of Surgery, Sarawak General Hospital, Kuching, MalaysiaDepartment of Surgery, Sarawak General Hospital, Kuching, MalaysiaDepartment of Surgery, Borneo Medical Centre, Kuching, MalaysiaBackground/Objective: The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution. Methods: This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014. Results: A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n = 63, 48.1% vs. open repair, n = 68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p = 0.434), gender (p = 0.305), body mass index (p = 0.180), and presence of comorbidities (p = 0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p = 0.769), Boey scores 0/1 (p = 0.311), Mannheim Peritonitis Index > 27 (p = 0.528), shock on admission (p < 0.99), and the duration of symptoms > 24 hours (p = 0.857). There was no significant difference in the operating time between the two groups (p = 0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p = 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p = 0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p = 0.008) and lower pain scores in the immediate postoperative period (p < 0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99). Conclusion: Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group.http://www.sciencedirect.com/science/article/pii/S101595841630210Xlaparoscopicopenperforated peptic ulcerstandardized techniquesurgical outcomes |
| spellingShingle | Sze Li Siow Hans Alexander Mahendran Chee Ming Wong Mark Hardin Tien Loong Luk Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique Asian Journal of Surgery laparoscopic open perforated peptic ulcer standardized technique surgical outcomes |
| title | Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique |
| title_full | Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique |
| title_fullStr | Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique |
| title_full_unstemmed | Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique |
| title_short | Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique |
| title_sort | laparoscopic versus open repair of perforated peptic ulcer improving outcomes utilizing a standardized technique |
| topic | laparoscopic open perforated peptic ulcer standardized technique surgical outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S101595841630210X |
| work_keys_str_mv | AT szelisiow laparoscopicversusopenrepairofperforatedpepticulcerimprovingoutcomesutilizingastandardizedtechnique AT hansalexandermahendran laparoscopicversusopenrepairofperforatedpepticulcerimprovingoutcomesutilizingastandardizedtechnique AT cheemingwong laparoscopicversusopenrepairofperforatedpepticulcerimprovingoutcomesutilizingastandardizedtechnique AT markhardin laparoscopicversusopenrepairofperforatedpepticulcerimprovingoutcomesutilizingastandardizedtechnique AT tienloongluk laparoscopicversusopenrepairofperforatedpepticulcerimprovingoutcomesutilizingastandardizedtechnique |