Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair.

INTRODUCTION: Peptic ulcer disease (PUD) is a rare condition in children. Perforated peptic ulcer (PPU), a complication of PUD has an estimated mortality between 1.3% and 20%. We evaluate incidence and outcomes of PPU in children using an administrative database, perform a review of the literature, and report our technique for laparoscopic omental patch repair for PPU in two pediatric patients. MATERIALS AND METHODS: Kids' inpatient database (KID's) was analyzed for demographics, incidence, and outcomes. Incidence for each year was calculated based on the reported pediatric population in the United States for 2000, 2003, 2006, 2009, and 2012 by the U.S. Census Bureau. Additionally, we present two PPU cases, accompanied by a comprehensive review of the literature. RESULTS: The annual number of primary discharge diagnosis of PPU in the KID was 178 cases for 2000, 252 for 2003, 255 for 2006, 299 for 2009, and 266 for 2012. An increase trend over time was noted between 2000 and 2009; however, it was not statistically significant (0.05). PPU appears to be more common in Caucasian teenage boys. The mean length of stay was 8.02 days and with a statistically significant increase in healthcare charges ($33,187 versus $78,142, P = .002) when comparing year 2000-2012. DISCUSSION: PPU is a rare cause of abdominal pain in children, but still a PUD complication that requires surgery. PPU should be included in the differential diagnosis in patients presenting with acute abdominal pain of uncertain etiology and pneumoperitoneum. Laparoscopy is both diagnostic and therapeutic. Laparoscopic omental patch repair is a safe and effective treatment for PPUs.

A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers.

BACKGROUND: Although laparoscopic repair (LR) of perforated peptic ulcers (PPUs) has long been accepted, clinical evidence comparing LR versus open repair (OR) remains lacking. Consequently, this study compared the clinical outcomes and cost-effectiveness of LR versus OR. METHODS: From January 2010 to June 2014, 119 patients with PPU were divided randomly into LR (58 patients) and OR (61 patients) groups that were comparable in age, sex, smoking and drinking history, symptom duration, comorbidity, American Society of Anesthesiologists grade, Boey score, and white blood cell count. RESULTS: The operative times for LR versus OR did not differ greatly (70 [interquartile range 60-90] vs 75 [60-90] minutes, respectively, P = .692), nor did postoperative complications. The LR group, however, required substantially less fentanyl than the OR group (0.74 ± 0.33 mg vs 1.04 ± 0.39 mg, P < .001). Moreover, the duration of hospital stay for the LR group was much shorter than those of the OR group (7 [5-9] vs 8 [7-10] days, respectively, P < .001). Although total hospital costs were similar (P = .465), the median intraoperative costs were greater for LR than for OR patients, at ¥6772 and ¥5626, respectively (P < .001). The median cost of ward stay tended to be ¥865 less in the LR group but was not statistically relevant. CONCLUSION: LR and conventional OR are comparable in terms of operative duration and complications. The obvious advantage of LR is the greatly decreased hospital stay and less postoperative pain, at similar total hospital costs. Therefore, LR may be preferable for treating PPU in selected patients.

Cost-efficiency and outcomes in the treatment of perforated peptic ulcer disease: laparoscopic versus open approach.

PURPOSE: Laparoscopic treatment of perforated peptic ulcer disease (perfPUD) has demonstrated comparable operative outcomes with an open approach though the cost-efficiency of this method has not been studied. METHODS: Data were obtained from the Nationwide Inpatient Sample (2007-2010). Patients who underwent operation for perfPUD were divided on the basis of laparoscopic or open approach. The primary outcome measures were hospital duration of stay, mortality, and total charges. RESULTS: A total of 5,361 patients with perfPUD were identified: 5,219 in the open group and 142 in the laparoscopic group. Patients in the laparoscopic group were younger (50.5 vs 60.0, P < .001) and had a lesser incidence at presentation of sepsis (8.5 vs 14.8%, P = .034) and shock (2.1 vs 7.7%, P = .012). On univariate analysis, the laparoscopic group had decreased duration of stay (7.0 vs 8.0 days, P < .001), lesser rates of mortality (3.5 vs 8.1%, P = .048), and were discharged to home more frequently (79.6 vs 68.1%, P = .025). Mean total charges were less in the laparoscopic group ($44,095 vs $52,055, P = .019). Multivariate analyses failed to show a difference between groups for any of the outcome variables. CONCLUSION: The laparoscopic treatment of perfPUD is associated with equivalent costs and outcomes compared with the open technique when we corrected for presentation variables.