Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study.

Autor: Alhaj Saleh A; Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA., Esquivel EC; Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA., Lung JT; Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA., Eaton BC; Department of Surgery, University of Maryland Medical System, Baltimore, MD, USA., Bruns BR; Department of Surgery, University of Maryland Medical System, Baltimore, MD, USA., Barmparas G; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Margulies DR; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Raines A; Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA., Bryant C; Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA., Crane CE; Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA., Scherer EP; Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA., Schroeppel TJ; Department of Surgery, UCHealth Memorial Hospital Center, Colorado Springs, CO, USA., Moskowitz E; Department of Surgery, UCHealth Memorial Hospital Center, Colorado Springs, CO, USA., Regner J; Department of Surgery, Baylor Scott and White Health, Temple, TX, USA., Frazee R; Department of Surgery, Baylor Scott and White Health, Temple, TX, USA., Campion EM; Department of Surgery, Department of Surgery, Denver Health Medical Center, Denver, CO, USA., Bartley M; Department of Surgery, Department of Surgery, Denver Health Medical Center, Denver, CO, USA., Mortus J; Department of Surgery, Baylor College of Medicine, Ben Taub, TX, USA., Ward J; Department of Surgery, Baylor College of Medicine, Ben Taub, TX, USA., Almekdash MH; Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA., Dissanaike S; Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA. Electronic address: Sharmila.Dissanaike@ttuhsc.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2019 Dec; Vol. 218 (6), pp. 1060-1064. Date of Electronic Publication: 2019 Sep 11.
DOI: 10.1016/j.amjsurg.2019.09.002
Abstrakt: RCTs showed benefits in Lap repair of perforated peptic ulcer (PPU). The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice. Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included. 461 PATIENTS: Open in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0-67%). Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p < 0.05) as was unplanned re-operation (4.7% vs 14%, p < 0.05). Lap reduced LOS (6 vs 8 days, p < 0.001). Ileus was more in Lap (42% vs 18 p < 0.001) operative time was 14 min higher in Lap(p < 0.01) and admission to OR time was 4 h higher in Lap(<0.05). No significant difference readmission or mortality. Our results suggest Lap should be considered a first-line option in suitable PPU patients requiring omental patch repair in centers that have the capacity and resources 24/7.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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