The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer.
World J Surg
; 39(3): 740-5, 2015 Mar.
Article
en En
| MEDLINE
| ID: mdl-25371298
ABSTRACT
BACKGROUND:
The use of laparoscopic repair for perforated peptic ulcer (PPU) was shown to be safe and recommended in low-risk patients. However, whether the approach is safe to apply to high-risk patients is uncertain. STUDYDESIGN:
This was a retrospective study of all patients with PPU admitted between January 2002 and December 2012. The laparoscopy-first approach (LFA) was adopted as a routine for all patients. The outcomes of LFA for PPU were reviewed and assessed to determine if the approach was safe in high-risk patients.RESULTS:
Three hundred and seventy three patients that suffered from PPU were included into the study and 50.9% received laparoscopic repair. There was a significant increase in the number of operations performed yearly by the LFA (P < 0.001). 25.2% of the patients had a Boey score of ≥2. High-risk patients that received LFA suffered from larger ulcers (P < 0.001) with more severe contamination (P = 0.006) that required conversion (P = 0.002) when compared to the low-risk patients. When compared to open surgery, more high-risk patients in the open group had ASA grade ≥3 (P = 0.007) and suffered from mortality (P = 0.001). The only significant predictor to mortality in high-risk patients was ASA grade ≥3 (P = 0.014).CONCLUSIONS:
The adoption of LFA in patients suffering from PPU was associated with acceptable rates of mortality and morbidity. The approach could also be selectively adopted in patients with Boey score ≥2 provided their ASA grading is low and hemodynamically stable.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Úlcera Péptica Perforada
/
Índice de Severidad de la Enfermedad
/
Laparoscopía
Tipo de estudio:
Etiology_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
World J Surg
Año:
2015
Tipo del documento:
Article