Management of Perforated Peptic Ulcer in a District General Hospital

Overview

Journal Ann R Coll Surg Engl

Specialty General Surgery

Date 2011 Nov 2

PMID 22041238

Citations 2

Authors

A C Critchley

A W Phillips

S M Bawa

P V Gallagher

Affiliations

Soon will be listed here.

Abstract

Introduction: Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons.

Methods: Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality.

Results: The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p <0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs.

Conclusions: Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

Citing Articles

An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer.

Zhou C, Wang W, Wang J, Zhang X, Zhang Q, Li B Sci Rep. 2015; 5:13976.

PMID: 26350958 PMC: 4563564. DOI: 10.1038/srep13976.

Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality.

Thorsen K, Soreide J, Kvaloy J, Glomsaker T, Soreide K World J Gastroenterol. 2013; 19(3):347-54.

PMID: 23372356 PMC: 3554818. DOI: 10.3748/wjg.v19.i3.347.

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