Laparoscopic Omental Patch Repair Research Articles

A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer.

The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, -2.84 days; 95% CI, -3.63 to -2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. Systematic Review and Meta-Analysis; Level IV.

Perforated marginal ulcer after gastric bypass for obesity: a systematic review

Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m2. Most of the patients had undergone a Roux-en-Y gastric bypass (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5±8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a computed tomography scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic proton pump inhibitors or H2 blockers at the time of perforation, and 41% of patients were smoking at the time. Twenty-three percent of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery, and 20% were managed non-surgically. Thirty-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and nonsurgically, respectively. Ulcers recurred in 5% of patients. In conclusion, PMU is a surgical emergency aftergastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterizing this condition.

Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report

BackgroundPerforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome.Case presentationA 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition.ConclusionsPerforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Background: Despite advances in the medical management of peptic ulcer disease, duodenal ulcer (DU) perforation remains a common surgical emergency. Most DU perforations are small and can be managed with omental patch repair. However, occasionally the surgeon may encounter a giant perforation not amenable to this. Giant DU perforations are defined as &gt; 2cm. They are associated with high leak rates and mortality. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities. Furthermore, there are no specific recommendations for their management despite a variety of repair techniques being described. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature. Case presentation: Four patients with giant DU perforation underwent emergency laparotomy and repair with our duodenojejunostomy technique at our hospital. Post-operatively, patients were monitored clinically and radiologically and discharged when well and tolerating diet. The mean age of the patients was 67 years with an equal gender distribution. The average Charlson Comorbidity Index (CCI) score was 3 (moderately severe). All presented with peritonitis and two had concomitant bleeding. There were two anterior and two posterior ulcers. One was a revision repair after a leak post laparoscopic omental patch repair for the initial perforation. In all cases, the duodenojejunostomy repair technique was used. Post-operative recovery was uneventful for all except one who developed pneumonia. In particular; there were no anastomotic leaks, intra-abdominal collections, gastric outlet obstructions or mortalities. Conclusion: Giant DU perforation remains a challenge to the general surgeon, particularly so in elderly patients with multiple comorbids. A review of the current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy. Here, we propose that isolated duodenojejunostomy can be a quick, safe and novel solution that ensures definitive repair of giant ulcer perforation in a single setting in the high-risk patient.

Laparoscopic omental patch repair for perforated peptic ulcer: an early experience from Al-Sahel Teaching Hospital

Background Peptic ulceration is a common condition. The most common etiologic factors are drugs use like NSAIDs and infection by Helicobacter pylori. The perforated duodenal ulceration is not an uncommon surgical emergency, ur aim was to show our experience with Laparoscopic omental patch repair for perforated peptic ulcer. Patient and Method In this study, we included 16 patients who underwent laparoscopic repair of perforated duodenal ulcer at our department. The patients were urgently admitted to the emergency department. Result In our study, we have neither morbidity nor mortality. The recorded time for the operation was 72–90 min, and the median hospital stay was 6 days. Our study confirms the safety of laparoscopic approach in the treatment of perforated peptic duodenal ulcer. Conclusion Laparoscopic omental patch repair for perforated peptic ulcer is safe and practical.

Laparoscopic versus open operation for perforated peptic ulcer in pediatric patients: A 10-year experience

BackgroundPerforated peptic ulcer (PPU) is a relatively uncommon condition in children. We aim to evaluate and compare the outcomes of laparoscopic omental patch repair versus open repair for PPU in pediatric patients. MethodsChildren who underwent omental patch repair for PPU from 2004 to 2014 in our hospital were reviewed retrospectively. Patient demographics, perioperative as well as intraoperative details and surgical outcomes, were analyzed. ResultsThirteen patients were identified, and all presented with abdominal pain. The median age of the study group was 14.9years (range 6.3 to 18.4years). Radiological evidence of pneumoperitoneum on erect chest x-ray (CXR) was found only in five patients (38.5%). None of the patients had a known history of peptic ulcer disease. Diagnosis other than PPU was made in five patients preoperatively. Laparoscopic repair was attempted in eight patients with one of them requiring conversion. There was no significant difference in patient demographics when compared with the open repair group. The perforation site was in the duodenum in 11 patients and in the antrum in two patients. The mean size of perforation was larger in the open repair group (p=0.005). Although the operating time was longer in the laparoscopic group (p=0.51), the length of hospital stay was significantly shorter (p=0.048). Only two patient diseases were Helicobacter pylori related. ConclusionClinical features of perforated peptic ulcer in children are different from adults. Risk factors are less frequently identified. Laparoscopic omental patch repair is a feasible surgical option and is associated with satisfactory outcomes in pediatric practice.

Strict Selection Criteria During Surgical Training Ensures Good Outcomes in Laparoscopic Omental Patch Repair (LOPR) for Perforated Peptic Ulcer (PPU).

Application of minimal access surgery in acute care surgery is limited due to various reasons. Laparoscopic omental patch repair (LOPR) for perforated peptic ulcer (PPU) surgery is safe and feasible but not widely implemented. We report our early experience of LOPR with emphasis on strict selection criteria. This is a descriptive study of all patients operated on for PPU at academic university-affiliated institutes from December 2010 to February 2012. All the patients who were operated on for LOPR were included as the study population and their records were studied. Perioperative outcomes, Boey score, Mannheim Peritonitis Index (MPI), and physiologic and operative severity scores for enumeration of mortality and morbidity (POSSUM) scores were calculated. All the data were tabulated in a Microsoft Excel spreadsheet and analyzed using Stata Version 8.x. (StataCorp, College Station, TX, USA). Fourteen patients had LOPR out of a total of 45 patients operated for the PPU. Mean age was 46 years (range 22-87 years). Twelve patients (86%) had a Boey score of 0 and all patients had MPI < 21 (mean MPI = 14). The predicted POSSUM morbidity and mortality were 36% and 7%, respectively. Mean ulcer size was 5 mm (range 2-10 mm), mean operating time was 100 minutes (range 70-123 minutes) and mean length of hospital stay was 4 days (range 3-6 days). There was no morbidity or mortality pertaining to LOPR. LOPR should be offered by acute care surgical teams when local expertise is available. This can optimize patient outcomes when strict selection criteria are applied.

Laparoscopic Repair of Perforated Duodenal Ulcer (Series of 50 Cases)

Background: Perforated peptic ulcer is a common surgical emergency. The classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overall utility. The aim of this study is to assess the efficacy of laparoscopic repair of perforated duodenal ulcer. Patients and Methods: This study included 50 patients presented by perforated peptic ulcer between July 2009 and August 2014. They were submitted to laparoscopic omental patch repair with thorough peritoneal wash. Patients’ demographics, diagnostic techniques, management and outcome were evaluated. Results: The mean age was 38.6 years with male to female ratio being 1.6:1. The perforation was diagnosed by plain X-ray abdomen in erect position in 43 patients and by abdominal CT scan in 7 patients. The laparoscopic repair of the perforation was successful in 48 patients while in 2 patients mid-line laparotomy was needed for proper control of the severe intra-abdominal sepsis. Post-operatively, all patients tolerated soft diet on the 3rd post-operative day and full diet on the 4th post-operative day. The mean duration of hospital stay was 4.5 days. Two patients developed post-operative intra-abdominal collection that was treated by ultrasound guided drainage, three patients developed umbilical port site wound infection while only two patients developed leakage, one of them reoperated after failed conservative surgery. No mortality was encountered in the study. Conclusion: Laparoscopic repair of perforated peptic ulcer is a safe and reliable technique with accepted morbidity and mortality rates with all the advantages of the minimally invasive surgery.

Laparoscopic Repair of Duodenal UlcerPerforation: A Randomized Controlled Clinical Trial

Background: Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated duodenal ulcer in many institutions. The literature established that laparoscopic repair of perforation when compared to open repair, is associated to lower wound dehiscence, less analgesic use, less pain and hospital stays. The drawbacks are length of operative time and the laparoscopic surgeon's experience in intra corporeal suturing and knotting. Methods: Over a one year period 83 patients presenting with perforated duodenal ulcer were randomly assigned to undergo either an open or a laparoscopic omental patch repair. They were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Those with clinically sealedoff perforations without signs of peritonitis or sepsis were treated without surgery. The endpoint was operative time, postoperative pain score, post-operative analgesic requirement, and length of postoperative hospital stay, morbidity, mortality and the date of return to normal daily activities. Results: Out of a total of 95 cases with diagnosis of duodenal perforations, 12 were excluded and 83 patients were analyzed. Both the groups were comparable in terms of age, gender, duration of symptoms, history of acid peptic disease, NSAIDs use, presence of comorbid conditions and size of perforation. Most of them presented after 24 hrs of onset of pain with the mean duration of 54.58 ± 32.4 hrs. There was one conversion in laparoscopic group due to intolerance to pneumoperitoneum. The duration of surgery was not significantly different but was high in the first five laparoscopic repairs (mean 91 mins as compared with 65 mins for the last 5 laparoscopic repairs). Those in laparoscopic group had significantly (p<0.001) less postoperative pain, analgesic requirement, time to return to normal diet, full ambulation and hospital stay. Morbidity was significantly high in open group (36.29 % vs 13.88 % in laparoscopic group; p 0.01). Open group had significantly high surgical site infection (19.14 vs 0%; p 0.005) and chest infection (29.78 vs 11.11%; p 0.04). One case in each group had mortality. Conclusion: Laparoscopic repair is safe and is a reliable procedure even in delayed presentation. It has significantly less postoperative pain, less need for analgesics, shorter hospital stay, early return to normal diet and work, and less complications without any difference in mortality.

Laparoscopic Treatment of Marginal Ulcer Perforation in a Patient with a Previous Roux-en Y Gastric Bypass

Marginal ulcer formation can occur in 10% of morbidly obese patients treated with Roux-en Y gastric bypass. Marginal ulcer perforation is a significant complication, occurring in a minority of patients (1%). Treatment options include either omental patch repair or anastomotic revision. A 36-year-old female who previously underwent laparoscopic Roux-en Y gastric bypass surgery 1 year ago, presented with sudden onset of abdominal pain, tachycardia, fever, and leukocytosis. A CT scan of the abdomen showed free air with no obvious source. The patient was taken to the operating room for laparoscopic exploration. At laparoscopy, purulent fluid was present in the abdominal cavity and evacuated. There was an obvious marginal ulcer perforation that was less than 1.0 cm in diameter. An omental patch was secured to the ulcer site with 2.0 vicryl sutures. A drain was left in situ. Total operating room time was 40 minutes. There were no complications. Postoperatively, she did well and was discharged home on day 5 with oral antibiotics and a proton pump inhibitor. Patients with a known history of Roux-en Y gastric bypass for morbid obesity, who present with abdominal pain with free air, should be explored emergently through laparoscopy by MIS trained surgeons or a bariatric surgeon to avoid the morbidity of an unnecessary laparotomy. Marginal ulcer perforation can be treated with laparoscopic omental patch repair safely and effectively. Runtime of video: 5 mins 20 secs

Laparoscopic repair of perforated peptic ulcer: A prospective study

Background: Perforated peptic ulcer is a common surgical emergency. Its classic treatment is the mid-line laparotomy. However, laparoscopic treatment has been shown to be reliable. Few studies have evaluated its overall utility. The aim of this study is to assess the efficacy of laparoscopy in perforated peptic ulcer repair. Patients and methods: The study included 18 patients presented by perforated peptic ulcer between July 2009 and December 2011. They were submitted to laparoscopic omental patch repair with thorough peritoneal wash. Patients' demographics, diagnostic techniques, management, and outcome were evaluated. Results: The mean age was 35.6 years. Male to female ratio was 14:4. The mean duration of symptoms was 18 hours. The perforation was diagnosed by plain X-ray of the abdomen in erect position in 15 patients and by abdominal CT scan in 3 patients.The laparoscopic repair of the perforation was successful in 16 patients while in 2 patients mid-line laparotomy was needed for proper control of the severe intra-abdominal sepsis. The mean operative time was 90 minutes. Post-operatively, the VAS score ranged between 3 and 6 with a mean of 3.5 in the first post-operative day. Narcotics were needed for a mean of 1.5 days. All the patients tolerated soft diet on the 3rd post-operative day and full diet on the 4th post-operative day. The mean duration of hospital stay was 4.5 days. One patient developed post-operative intra-abdominal collection that was treated by ultrasound guided drainage. One patient developed umbilical port site wound infection. No chest infection, prolonged ileus, leakage, or mortality was encountered in the study. Conclusion: Laparoscopic repair of perforated peptic ulcer is a safe and reliable technique with accepted morbidity and mortality rates and all the advantages of the minimally invasive surgery.

Perforated Peptic Ulcer in an Adolescent Girl

A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.5-year-old adolescent girl who developed abdominal and shoulder pain that resolved after 1 day. She was then completely well for 2 days until the abdominal and shoulder pain recurred. On examination, she appeared well, but in pain. A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. Result of a urea breath test to detect Helicobacter pylori was negative. The differential diagnosis of pneumoperitoneum in children is discussed, as are childhood perforated peptic ulcer in general, and the unique clinical features present in this case in particular.

Laparoscopic Repair of Perforated Peptic Ulcer with Delayed Presentation

Laparoscopic repair has been used to treat perforated peptic ulcers since 1990 and is gaining acceptance. The main concerns are postoperative intra-abdominal collections and performing laparoscopy in the presence of peritonitis. From June 2006 to June 2008, 31 patients presenting with a clinical diagnosis of perforated peptic ulcer with peritonitis who underwent laparoscopic omental patch repair were selected. Patients who presented more than 24 hours after the onset of pain were only included for this analysis. Conversion criteria were malignant ulcers, perforations larger than 10 mm, or for technical difficulties. The degree of peritonitis was noted and a thorough wash given. The perforation was repaired by the standard omental patch technique, and the number of sutures were decided according to the size of the perforation. Endpoints were operative time, postoperative pain, length of postoperative hospital stay, and complications. There were 2 conversions due to technical difficulties. Laparoscopic repair required an average of 105 minutes to complete. The median postoperative stay was 5.5 days while mean duration of pain was 3 days. Four patients had port-site infections and 5 had intra-abdominal collections, which were managed conservatively. There were no chest infections or mortality in our series. Laparoscopic repair of perforated peptic ulcer is a safe, reliable procedure even in delayed presentations with peritonitis. It has an acceptable morbidity and all the advantages of the minimally invasive surgical approach.

Routine laparoscopic single-stitch omental patch repair for perforated peptic ulcer: experience from 338 cases

Routine laparoscopic single-stitch omental patch repair for perforated peptic ulcer: experience from 338 cases

Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler

Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler

NON-OPERATIVE TREATMENT FOR PERFORATED DUODENAL ULCER

The aim of this study is to review our recent experience with selective non-operative management of perforated duodenal ulcers (PDU). The patients included in this study had PDU treated non-operatively between 1995–2002. The protocol for the management of PDU has been developed based on experience at our department. Our policy of the selective treatment for PDU was that patients over 65 years old had immediate laparoscopic omental patch repair (LOPR) and the other was selected non-operative management. Non-operative management consisted of intravenous fluids, broad-spectrum antibiotics, nasogastric tube suction (occasionally) ultrasound guided percutaneous drainage of intraperitoneal fluids (occasionally) and H2 blockers. All patients had emergency endoscopies before treatments and were made diagnoses of PDU. If evidence of peritonitis progressed, or if there was not evidence of regression by 24–48 hours, laparoscopic surgery was indicated. Endosopic examination was performed on about 4–5th day, and if the perforation sealing was confirmed, oral diet resumption was then started. Helicobacter pylori (HP) status was checked after discharge. One hundred twenty-six PDU patients were evaluated. The patients ranged in age from 17 to 99 years old, with a mean age of 49 years. Males predominated in a ratio of 4:1. Ninety-nine (79%) of the 126 cases with PDU had non-operative treatment. There were 85 men and 14 women. Non-operative treatment was abandoned in 9 cases (9%) due to deteriorating peritonitis and converted to laparoscopic interventions. Mean hospital stay for the 27 patients treated operatively was 30+-22 days; the mean hospital day of the 99 patients primarily treated non-operatively was 20+-11 days. Re-perforation did not occur. The overall mortality rate was 7%. The mortality rate for the patients treated operatively was 26%; the mortality of the patients primarily treated non-operatively was 2%. The1death in this latter group occurred in a man with cardiopulmonary arrest on arrival and the other death occurred in a man with chronic pulmonary failure. Overall positive rate of IgG and HP status was 73 and 56%, respectively. Non-operative management for the relatively younger patients with PDU can be safely performed. We emphasize in our study the labour intensive process that is required to achieve acceptable results.

CASE REPORT OF TRICHOBEZOAR CAUSING GASTRIC PERFORATION

A 17‐year‐old girl with trichophagia (hair eating) habits was admitted to our hospital because of severe acute epigastralgia in June 1997. Abdominal computed tomography showed free air in the abdominal cavity and a heterogeneous mass in the stomach and the duodenum. A perforation on the anterior wall of the lower gastric body was found by urgent laparoscopic surgery and thus a laparoscopic omental patch repair was performed. Endoscopic examination after the operation revealed a large trichobezoar and gastric ulcers. An attempt made by us to extract the bezoar by endoscopy using a flexible outer‐tube was unsuccessful. The gastric ulcer relapsed in November 1997. Another attempt was made to extract the bezoar with laparoscopic instrumentation using a percutaneous gastrostomy port associated with oral gastroendoscopy. Only the part of the bezoar in the duodenum was extracted, and multiple superficial ulcers and erosions in the second part of the duodenum were found. Removal of the entire bezoar in the stomach required surgical gastrostomy. An endoscopic examination after the operation revealed healing of the gastric ulcer and duodenal erosions. Gastric perforation due to trichobezoar is a rare complication. Since the attempt to remove the trichobezoar in a minimally invasive manner failed, a surgical gastrostomy was required.

Laparoscopic Omental Patch Repair for Perforated Duodenal Ulcer

A retrospective review was carried out on 33 consecutive patients with omental patch repair for perforated duodenal ulcer; 13 had laparoscopic repair, and 20 had open repair. Laparoscopic repair was successful in 12 patients, with only one postoperative complication (8%). The morbidity rate for open repair was 15 per cent (3 of 20), and there was one postoperative death in the open group (5%). Overall, it did not take longer to perform the operation laparoscopically than the open method. Patients in the laparoscopic group required less postoperative analgesia (mean doses, 0.2 vs 0.9; P = 0.02). There was no difference in terms of hospital stay and resumption of diet after operation between the two groups. Laparoscopic omental patch repair offers a safe alternative to the open method in the treatment of perforated duodenal ulcer.