Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study
| Autor: | Malagoli M, Stefania Caramaschi, Luca Reggiani Bonetti, Gianrocco Manco, Giovanni Rolando, Giuliana Zanelli, Aldo Rossi |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal Abscess Adolescent Multiple Organ Failure Perforation (oil well) Anastomotic Leak Conservative Treatment Helicobacter Infections 03 medical and health sciences Young Adult 0302 clinical medicine Peptic Ulcer Perforation Postoperative Complications medicine Humans Helicobacter pylori Laparoscopy Peptic ulcer perforation Aged Retrospective Studies Surgical repair Aged 80 and over biology medicine.diagnostic_test business.industry Wound Closure Techniques Incidence (epidemiology) Suture Techniques Retrospective cohort study Middle Aged biology.organism_classification Prognosis digestive system diseases Surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female Emergencies Complication business |
| Zdroj: | Minerva chirurgica. 75(6) |
| ISSN: | 1827-1626 |
| Popis: | Background Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers. Methods Clinical and surgical data on 42 patients underwent surgical treatment for perforated peptic ulcer from January 2012 to December 2016 were collected. Laparoscopic repair of the perforation with a three-port technique was made in all cases. The Boey scoring system was used to predict the prognosis. Results All patients underwent suture-closure of the ulcer, and omental patch through laparoscopy without conversion to open surgery. Duodenal leakages occurred in 3 patients (7.1%), then treated with a conservative approach and resolved on the 10th postoperative day. Two patients (4.7%) had deep space infections in the first week after surgery, therefore subdiaphragmatic and pelvic abscess were drained by ultrasound guidance. Four patients (9.5%) died up to 30-day post-surgery due to progression of multisystem organ failure in absence of leakages or infections. All these patients were American Society of Anesthesiologists Classification >III and Boey Score 3. Conclusions Our data show that a primary laparoscopic approach in patients with peptic ulcer perforation is associated with postoperative advantages and acceptable rates of morbidity and mortality, essentially related to high Boey Score. Therefore, we suggest that the surgical repair of PPU could be always started laparoscopically. |
| Databáze: | OpenAIRE |
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