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Saleem AEAA, Arafa MW, Galal AM. A comparative study of laparoscopic versus laparotomy repair of perforated peptic ulcer: A prospective study. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:385-401. [DOI: 10.4103/ejs.ejs_65_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background
Laparoscopic surgery is still gaining popularity in conditions associated with peritonitis, such as a perforated peptic ulcer.
Aim of the work
This study aimed to compare laparoscopic and laparotomy repair of perforated peptic ulcers regarding intraoperative parameters, postoperative pain, time of the start of oral feeding, postoperative complication, hospital stay, resuming normal activity, and outcomes.
Patients and methods
This is a prospective study of 50 patients (males and females), of any age with perforated peptic ulcer. Those patients will be divided by the random serial number method into two groups: the
laparoscopic group
and the
open (laparotomy) group.
In a period from 15th April 2022 to 15th February 2023 data related to patients were recorded and subjected to analysis.
Results
All patients were divided into two groups:
Laparoscopic group
with 25 patients (23 of them underwent successful laparoscopic repair and two patients were converted to open) and the
open (laparotomy) group
with 25 patients underwent laparotomy repair (of which 23 patients were living, and two patients died on the third and tenth postoperative days). There were no significant differences in baseline characteristics between both groups in terms of age, gender, special habits, preoperative risk factors, comorbidities, laboratory, and radiological findings; also both groups showed insignificant differences regarding the American Society of Anesthesiologists (ASA) scores (P=0.83), total Boey’s score (P=0.77), shock on admission (P= 1.00), and the duration of symptoms > 24 hours (P= 0.77). Operative time was significantly increased in the laparoscopic versus open group (P=0.0001). While, first-day pain score (VAS), opioid requirements, time of starting oral feeding, length of hospital stay, and return to normal activity were highly significantly decreased in laparoscopic repair compared with open repair (P= <0.0001 for each). Total postoperative complications showed insignificant difference between the studied groups (P=0.16), but they were more prevalent between the open group (14 patients, 56%) versus the laparoscopic group (9 patients, 36%). Good cosmetic results of wounds were more prevalent in the laparoscopic group [20 patients (80.00%)] than the open group [13 patients (56.52%)], but insignificant, P=0.17.
Conclusion
Laparoscopic repair had an upper hand over open repair regarding less intraoperative blood loss, less postoperative pain, requiring less postoperative analgesia, early starting of oral feeding, less postoperative complications, shorter hospital stay, early return to normal activity, and good cosmetic results of wounds.
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Affiliation(s)
- Abd-El-Aal A. Saleem
- Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed W. Arafa
- General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
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Tsao LC, Lin J, Lin KH, Ng SY, Huang CY, Hung YJ, Wu SC, Gao SL, Yu SF, Lin CC, Chang WJ. Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease. Sci Rep 2023; 13:1170. [PMID: 36670125 PMCID: PMC9860010 DOI: 10.1038/s41598-023-27471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution's prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.
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Affiliation(s)
- Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan
| | - Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
- Department of Animal Science and Biotechnology, Tunghai University, Taichung, 407, Taiwan
- Department of General Surgery, Yuanlin Christian Hospital, Yuanlin, 510, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Sze-Yuin Ng
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Cheng-Yen Huang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Yu-Ju Hung
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Szu-Chia Wu
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shih-Ling Gao
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Shu-Fen Yu
- Department of Nursing, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Chi-Chien Lin
- Institute of Biomedical Science, College of Life Sciences, National Chung-Hsing University, Taichung, 402, Taiwan.
- Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan.
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Wei-Jung Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan.
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Donohue SJ, Reinke CE, Evans SL, Jordan MM, Warren YE, Hetherington T, Kowalkowski M, May AK, Matthews BD, Ross SW. Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system. Surg Endosc 2022; 36:3822-3832. [PMID: 34477959 DOI: 10.1007/s00464-021-08699-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes. METHODS Our integrated health care system's EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care. RESULTS Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m2 vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23-17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor. CONCLUSION Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.
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Affiliation(s)
- Sean J Donohue
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Susan L Evans
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Mary M Jordan
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Yancey E Warren
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Timothy Hetherington
- Carolinas Medical Center, Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Marc Kowalkowski
- Carolinas Medical Center, Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Addison K May
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Brent D Matthews
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
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