Abstract
BackgroundLaparoscopic repair is a well-accepted treatment modality for perforated peptic ulcer (PPU). However, intraoperative conversion to laparotomy is still not uncommon. We aimed to identify preoperative factors strongly associated with conversion.MethodsA retrospective review of records of all PPU patients treated between January 2011 and July 2019 was performed. Patients were divided into three groups: laparoscopic repair (LR), conversion to laparotomy (CL), and primary laparotomy (PL). Patient demographics, operative findings, and outcomes were compared between the groups. Logistic regression analyses were performed, taking conversion as the outcome.ResultsOf 822 patients, there were 236, 45, and 541 in the LR, CL, and PL groups, respectively. The conversion rate was 16%. Compared with those in the LR group, patients in the CL group were older (p < 0.001), had higher PULP scores (p < 0.001), had higher ASA scores (p < 0.001) and had hypertension (p = 0.003). PULP score was the only independent risk factor for conversion. The area under the curve (AUC) for the PULP score to predict conversion was 75.3%, with a best cut-off value of ≥ 4. The operative time was shorter for PL group patients than for CL group patients with PULP scores ≥ 4. For patients with PULP scores < 4, LR group patients had a shorter length of stay than PL group patients.ConclusionThe PULP score may have utility in predicting and minimizing conversion for laparoscopic PPU repair. Laparoscopic repair is the procedure of choice for PPU patients with PULP scores < 4, while open surgery is recommended for those with PULP scores ≥ 4.
Highlights
Peptic ulcer disease is a common disease worldwide with an annual incidence of 0.1–0.3% [1]
The percentage of patients who had a prolonged interval between symptom onset and hospital admission and the percentage of patients who were hypotensive upon admission were similar between the laparoscopic repair (LR) and conversion to laparotomy (CL) groups and were not associated with conversion (Table 2)
When both subgroups were further propensity matched by the peptic ulcer perforation (PULP), Boey and American Society of Anesthesiologist (ASA) scores in a 1:2 ratio, our results revealed that the average operation time of the CL group patients was significantly longer than that of the primary laparotomy (PL) group patients (205 ± 72.2 vs. 164 ± 85 min, p = 0.022)
Summary
Peptic ulcer disease is a common disease worldwide with an annual incidence of 0.1–0.3% [1]. Perforated peptic ulcer (PPU) remains a surgical emergency and is still associated with a high mortality rate of approximately 8.55–30.0% [3,4,5,6]. Laparoscopic repair is a well-accepted treatment modality for perforated peptic ulcer (PPU). Compared with those in the LR group, patients in the CL group were older (p < 0.001), had higher PULP scores (p < 0.001), had higher ASA scores (p < 0.001) and had hypertension (p = 0.003). Conclusion The PULP score may have utility in predicting and minimizing conversion for laparoscopic PPU repair. Laparoscopic repair is the procedure of choice for PPU patients with PULP scores < 4, while open surgery is recommended for those with PULP scores ≥ 4
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