Laparoscopic Simple Closure Research Articles

Study of Risk Factors Leading to Conversion of Laparoscopic Simple Closure to Open Surgery in Perforated Peptic Ulcer

Study of Risk Factors Leading to Conversion of Laparoscopic Simple Closure to Open Surgery in Perforated Peptic Ulcer

No Abdominal Drainage After Single-Port Laparoscopic Repair for Perforated Duodenal Ulcers

Nowadays, closure of the perforation with or without omental patch is the main surgical approach for most perforated duodenal ulcer. There have been limited high-quality studies to clarify the role of drainage after perforated duodenal ulcer laparoscopic repair. We performed this study to evaluate the role of abdominal drainage after simple closure for the treatment of low-risk perforated duodenal ulcer. A consecutive case series was conducted including patients with size of duodenal perforation no more than 5 mm who underwent single-port laparoscopic simple repair at Hue University of Medicine and Pharmacy Hospital from January 2012 to June 2018. In this study, sixty-five executive perforated duodenal ulcer patients with the size of the perforation no more than 5 mm, an ASA score equal or less than 3, and a Boey score of 0 or 1 were treated by single-port laparoscopic simple repair. All patients (100%) had a perforation of the anterior side of duodenum. The mean size of the perforations was 3.4 mm. We did not use abdominal drainage after single-port laparoscopic simple closure without omentoplasty. There were no documented leakage of the repair site and no residual abscess postoperatively. The mean analgesic use duration was 2.8 ± 0.8 days. The mean hospital stay duration was 5.6 ± 0.8 days. At 30-day follow-up, one patient (1.5%) had wound infection. No port-site hernia was found and there was no mortality. For small-size and low-risk perforated duodenal ulcer, no-drainage after single-port laparoscopic simple repair is safe and effective. The patients without abdominal drainage require less analgesic use and have short hospital stay.

Laparoscopic simple closure for perforated duodenal ulcer in young adults

Laparoscopic simple closure for perforated duodenal ulcer in young adults

Laparoscopic repair of perforated peptic ulcer: simple closure versus omentopexy

BackgroundThis report presents our experience with laparoscopic repair performed in 118 consecutive patients diagnosed with a perforated peptic ulcer (PPU). We compared the surgical outcome of simple closure with modified Cellan-Jones omentopexy and report the safety and benefit of simple closure. MethodsFrom January 2010 to December 2014, 118 patients with PPU underwent laparoscopic repair with simple closure (n = 27) or omentopexy (n = 91). Charts were retrospectively reviewed for demographic characteristics and outcome. The data were compared by Fisher's exact test, Mann-Whitney U test, Pearson's chi-square test, and the Kruskal-Wallis test. The results were considered statistically significant if P < 0.05. ResultsNo patients died, whereas three incurred leakage. After matching, the simple closure and omentopexy groups had similarity in sex, systolic blood pressure, pulse rate, respiratory rate, Boey score, Charlson comorbidity index, Mannheim peritonitis index, and leakage. There were statistically significant differences in age, length of hospital stay, perforated size, and operating time. Comparison of the operating time in the ≤4.0 mm and 5.0-12 mm groups revealed that the simple closure took less time than omentopexy in both groups (≤4.0 mm, 76 versus 133 minutes, P < 0.0001; 5.0-12 mm, 97 versus 139.5 minutes; P = 0.006). ConclusionsCompared to the omentopexy, laparoscopic simple closure is a safe procedure and shortens the operating time.

Laparoscopic Management of Perforated Peptic Ulcer: Simple Closure or Something More?

Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2 - 6 hours from the onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40 - 100 min for the Graham patch repair and 120 - 155 min for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch” group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.

Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease—Results of a Double Institution Study of 35 Patients

BackgroundEndoscopic and interventional techniques are currently the mainstay of management of bleeding duodenal ulcer. As well, for patients with perforated duodenal ulcer, laparoscopic simple closure is nowadays usually performed. Although indications for emergency antroduodenectomy have declined, this procedure is still necessary as a salvage option when conservative management has failed or is not practicable. Our study aimed to evaluate indications and results of antroduodenectomy with gastroduodenal anastomosis in current practice and to examine the factors that predict operative outcomes. MethodsAll patients who underwent emergency antroduodenectomy with gastroduodenal anastomosis in two surgical care departments specialized in emergency digestive surgery were studied from 2000 to 2015. ResultsThirty-five patients (27 males, 77 %) with a median age of 68 years (20–90) underwent emergency antroduodenectomy with gastroduodenal anastomosis. Indications were bleeding and perforated duodenal ulcer in 24 and 11 patients, respectively. The overall complication rate was 69 %, especially because of a high rate of medical complications (57 %). Only two patients (6 %) required reoperation for anastomotic leakage. The overall mortality rate was 40 % (n = 14). According to the univariate analysis, age >70, >3 comorbidities, ASA score >2, and postoperative medical complications were associated with an increased risk of in-hospital mortality. In the multivariate analysis, age and ASA score remained independent risk factors. No recurrence of complicated duodenal disease was observed. ConclusionAntroduodenectomy with gastroduodenal anastomosis is a safe and effective long-term strategy, with a low and acceptable rate of surgical complications, for complicated duodenal ulcer not responding to conservative measures.

Risk factors associated with conversion of laparoscopic simple closure in perforated duodenal ulcer

BackgroundPrecise patient selection criteria are necessary to guide the surgeon in selecting laparoscopic repair for patients with perforated peptic ulcers. The aims of this study are to report surgical outcomes after surgery for perforated duodenal ulcers and identify risk factors for predicting failure of laparoscopic simple closure for perforated duodenal ulcer. MethodsIn total, 77 patients who underwent laparoscopic simple closure for perforated duodenal ulcers from January 2007 to September 2013 were retrospectively analyzed. Patients were divided into totally laparoscopic and conversion groups. The characteristics of patients, intraoperative findings, postoperative complications, conversion rates and suture leakage rates of each group were investigated. ResultsLaparoscopic repair was completed in 69 (89.6%) of 77 patients, while 8 (10.4%) underwent conversion to open repair. Patients in the conversion group had longer perforation time, larger perforation size, more suture leakage, longer hospital stay, and higher 30-day mortality rate than those in the totally laparoscopic group. The size of perforation was the only risk factor for conversion in multivariable analysis. Patients with an ulcer perforation size of ≥9 mm or with perforation duration of ≥12.5 h had a significantly increased risk for conversion and suture leakage. ConclusionsUlcer size of ≥9 mm is a significant risk factor for predicting conversion in laparoscopic simple closure. Suture leakage is associated with ulcer size (9 mm) and duration of perforation (12.5 h).

Outcome of laparoscopic repair of perforated duodenal ulcers

Laparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy. This was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score. Of the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort. LSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery

The therapeutic methods of iatrogenic colon perforation have not been performed despite the increasing rates of successful management by endoscopic clip closure. This study aimed to analyze the efficacy and complications of endoscopic clip closure and to identify the risk factors associated with the need for early surgery to avoid more invasive surgical interventions and adverse complications after endoscopic clip closure for iatrogenic colon perforation. A retrospective multicenter review of the clinical course experienced by 32 patients with iatrogenic colon perforation who were treated using immediate endoscopic clip closure between January 2005 and December 2009 was performed. The technical success rate for endoscopic clip closure was 91% (29/32). After endoscopic clip closure, 22 patients (76%) required medical treatment for colon perforation, and seven patients (24%) had surgical treatment. Of the 22 patients who had only endoscopic clip closure, 17 (59%) had a favorable clinical course. Five patients had a long hospital stay with complication including abscess formation (three cases). Four patients underwent early surgery within 24 h, and laparoscopic simple closure was possible. But for three patients with surgery delayed more than 48 h, open laparotomy with colon resection including diversion were required. The risk factors associated with the need for early surgical treatment within 24 h after endoscopic clip closure were a large perforation [odds ratio (OR), 9.25; 95% confidence interval (CI), 1.85-46.20], leukocytosis (OR 6.58; 95% CI 1.86-23.29), fever (OR 5.05; 95% CI 1.05-24.28), severe abdominal pain (OR 4.30; 95% CI 1.17-15.83), and a large amount of peritoneal free air (OR 4.05; 95% CI 1.40-11.71). The endoscopic clip closure procedure can significantly reduce the frequency of surgery among patients with iatrogenic colon perforations. However, the decision for surgery must be made early after endoscopic clip closure to prevent adverse complications for patients with higher risk factors.

Community‐based Evaluation of Laparoscopic versus Open Simple Closure of Perforated Peptic Ulcers

Several studies have advocated laparoscopic simple closure (LSC) as the treatment of choice for perforated peptic ulcer disease (PUD). However, there has been no comprehensive community-based evaluation of the advantages of using LSC over open simple closure (OSC). Using an administrative database, we evaluated LSC versus OSC for patients with perforated ulcers. From 6,334 patients with perforated ulcers, we identified 2,909 simple closure cases between 2006 and 2010. Study variables were demographics, mortality, co-morbidities, complications, ulcer location, surgical timing, blood transfusion, postoperative ventilation, operating room (OR) time, time to resumption of oral food intake, length of stay (LOS), and total charges. After matching patient baseline variables between OSC and LSC, we performed multivariate analyses to assess the impacts of LSC on mortality, complications, and ventilation administration. A total of 2,073 OSC cases and 836 LSC cases were identified in 670 hospitals. Younger age, duodenal ulcer, and pre-existing PUD were indicators for selection of LSC. Matching analysis indicated a correlation between LSC and lower mortality, less frequent postoperative and overall blood transfusion, shorter LOS, earlier return to oral intake, and longer OR time. There was no difference between OSC and LSC in complication rate or mortality. Longer OR time was correlated with a higher complication rate and the need for ventilation, the latter of which was independently associated with an increase in mortality. Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly.

Laparoscopic Simple Closure Alone is Adequate for Low Risk Patients with Perforated Peptic Ulcer

Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch.

Laparoscopic closure of perforated duodenal ulcer.

Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have been successful. Over a 1-year period (1996-97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic simple closure and omental patch. The mean age was 36.4 +/- 11.8 years (range, 18-61). Twenty patients were male (93.7%). The mean duration of pain was 9.1 +/- 11.7 hs (range, 2-48). Three patients had a previous history of duodenal ulcer (14.3%), and another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five patients had a minimal peritoneal reaction (23.8%). The mean operative time was 71.6 +/- 24.6 mins (range, 40-120), and the mean hospital stay was 5.2 +/- 1.6 days (range, 3-9). The mean time to resume oral fluids was 3.1 +/- 0.8 days (range, 2-4). Only one patient was reoperated due to leakage identified by gastrographin swallow. This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing therapy is still needed.

INDICATIONS OF THERAPIES FOR PERFORATED DUODENAL ULCER

A retrospective study was made of 40 cases of perforated duodenal ulcer experienced at the hospital from July 1991 to March 1997 to evaluate indications of therapies for the disease. There were 2 cases of conservative therapy, 13 cases of laparoscopic simple closure (LSC), 9 cases of open simple closure (OSC) and 16 cases of subtotal gastrectomy (SG). Durations from the onset of the disease until the operation were 7.3 hours in LSC, 34.2 hours for OSC and 27.5 hours in SG. The opration times were 1.4 hours in LSC, 1.2 hours in OSC and 2.8 hours in SG. The hospital stay amounted to 13.7 days in LSC, 18.8 days in OSC and 29.3 days in SG, whereas over 30 days in conservative theray. As to the medical cost on the health insurance, LSC amounted to 67, 326, OSC to 90, 434, the conservative method to 91, 492, SG to 116, 222 points Recurence of duodenal ulcer appeared in 38.5% of patients undergoing simple closure more than one year after the operation, but all such patients were treated by medication. From these findings, we think that the conservative therapy should be indicated for aged patients or inoperable patients with poor risk; and LSC is indicated first if there are no shock findings, then SG is indicated if duodenal stenosis is confirmed, and finally OSC should be selected if shock state or severe complications are confirmed.