Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study

Roberta Tutino, Tiziana Fiorentini, Gianfranco Cocorullo, Giuseppe Salamone, Eliana Gulotta, Leo Licari, Tiziana Fiorentini, Armando Speciale, Antonino Mirabella, Massimo Lupo, Giuseppina Irene Melfa, Nicolo' Falco, Paolino De Marco, Tommaso Fontana

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1 Citazione (Scopus)

Abstract

Background: Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2-4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods: Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey's score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient's age, surgical technique and Boey's score were evaluated. Results: The relationship between laparoscopic or open treatment and the Boey's score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients' Boey's score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey's score group and in the 10.7% of the high Boey's score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions: Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey's score. In our series laparoscopy was not used in high risk Boey's score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.
Lingua originaleEnglish
Numero di pagine0
RivistaDefault journal
Volume18
Stato di pubblicazionePublished - 2018

All Science Journal Classification (ASJC) codes

  • Surgery

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Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study. / Tutino, Roberta; Fiorentini, Tiziana; Cocorullo, Gianfranco; Salamone, Giuseppe; Gulotta, Eliana; Licari, Leo; Fiorentini, Tiziana; Speciale, Armando; Mirabella, Antonino; Lupo, Massimo; Melfa, Giuseppina Irene; Falco, Nicolo'; De Marco, Paolino; Fontana, Tommaso.

In: Default journal, Vol. 18, 2018.

Risultato della ricerca: Article

Tutino, Roberta ; Fiorentini, Tiziana ; Cocorullo, Gianfranco ; Salamone, Giuseppe ; Gulotta, Eliana ; Licari, Leo ; Fiorentini, Tiziana ; Speciale, Armando ; Mirabella, Antonino ; Lupo, Massimo ; Melfa, Giuseppina Irene ; Falco, Nicolo' ; De Marco, Paolino ; Fontana, Tommaso. / Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study. In: Default journal. 2018 ; Vol. 18.
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title = "Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study",
abstract = "Background: Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2-4{\%} of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods: Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey's score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient's age, surgical technique and Boey's score were evaluated. Results: The relationship between laparoscopic or open treatment and the Boey's score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1{\%} and high score group in 100{\%} and laparoscopy in 58.6{\%} and 0{\%}, respectively. Postoperative complications occurred in 9.7{\%} of patients which were related to the patients' Boey's score, 4.7{\%} in the low-mid score group and 21.4{\%} in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8{\%} in open technique and 5.3{\%} in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8{\%} and occurred in the 0.8{\%} of low-mid Boey's score group and in the 10.7{\%} of the high Boey's score group (p = 0.001). In respect to the surgical technique it occurred in 6.4{\%} of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions: Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey's score. In our series laparoscopy was not used in high risk Boey's score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.",
author = "Roberta Tutino and Tiziana Fiorentini and Gianfranco Cocorullo and Giuseppe Salamone and Eliana Gulotta and Leo Licari and Tiziana Fiorentini and Armando Speciale and Antonino Mirabella and Massimo Lupo and Melfa, {Giuseppina Irene} and Nicolo' Falco and {De Marco}, Paolino and Tommaso Fontana",
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TY - JOUR

T1 - Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: A retrospective multicenter study

AU - Tutino, Roberta

AU - Fiorentini, Tiziana

AU - Cocorullo, Gianfranco

AU - Salamone, Giuseppe

AU - Gulotta, Eliana

AU - Licari, Leo

AU - Fiorentini, Tiziana

AU - Speciale, Armando

AU - Mirabella, Antonino

AU - Lupo, Massimo

AU - Melfa, Giuseppina Irene

AU - Falco, Nicolo'

AU - De Marco, Paolino

AU - Fontana, Tommaso

PY - 2018

Y1 - 2018

N2 - Background: Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2-4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods: Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey's score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient's age, surgical technique and Boey's score were evaluated. Results: The relationship between laparoscopic or open treatment and the Boey's score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients' Boey's score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey's score group and in the 10.7% of the high Boey's score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions: Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey's score. In our series laparoscopy was not used in high risk Boey's score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.

AB - Background: Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2-4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods: Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey's score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient's age, surgical technique and Boey's score were evaluated. Results: The relationship between laparoscopic or open treatment and the Boey's score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients' Boey's score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey's score group and in the 10.7% of the high Boey's score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions: Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey's score. In our series laparoscopy was not used in high risk Boey's score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.

UR - http://hdl.handle.net/10447/303531

UR - http://www.biomedcentral.com/bmcsurg

M3 - Article

VL - 18

JO - Default journal

JF - Default journal

ER -