Evaluating the Evolving Morbidity of Omentoplasty for Perforated Peptic Ulcer Disease

2020 ◽  
Vol 86 (10) ◽  
pp. 1289-1295
Author(s):  
Noah Swann ◽  
Nobel LeTendre ◽  
Brian Cox ◽  
James Recabaren
Keyword(s):  
Laparoscopic Surgery ◽  
Laparoscopic Repair ◽  
Open Surgery ◽  
Surgical Repair ◽  
Open Repair ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Patch Repair ◽  
Perioperative Morbidity ◽  
Graham Patch

Mortality for perforated peptic ulcer (PPU) surgery ranges from 2-22% with morbidity ranging from 15-45%. Traditionally, these had been repaired with vagotomy and antrectomy or pyloroplasty with smaller perforations repaired with an omentoplasty. Laparoscopic repair has become increasingly prevalent and demonstrated to have shorter length of stay (LOS) and fewer complications. We are evaluating the surgical repair of PPU with omentoplasty to determine trends of utilization and surgical outcomes. We conducted a 13-year (2005-2017) retrospective review, utilizing the National Surgical Quality Improvement Program database. A total of 6873 patients had open or laparoscopic repair of a PPU, with 2285 patients identified as utilizing omentoplasty. Five hundred eighty-eight omentoplasty patients were further identified as having a laparoscopic technique. We compared patient demographics, comorbidities, and perioperative morbidity and mortality for surgical patients between 2005-2011 and 2012-2017. We trended the perioperative outcomes across the study intervals. Parametric and nonparametric tests were used to evaluate outcomes. Between 2005 and between 2017, laparoscopic surgical repair with omentoplasty has increased from 3.8% to 34.6%. Overall mortality for open operations declined during this interval (12.7%-9.3%) while it remained unchanged for laparoscopic operations (4.6%-4.2%), there was not a significant difference between the laparoscopic and open 30-day mortality. Both open surgery and laparoscopic surgery are being used on an increasingly healthy cohort (increased functional status decreased predicted perioperative morbidity). Relative to the 2005-2011, the laparoscopic surgery 2012-2017 cohort had increases in both serious and overall morbidity, although this was not statistically significant. Compared to the 2005-2011, the 2012-2017 open surgery cohort had increasing serious morbidity (OR 2.03) and overall morbidity (OR 1.91). There was a trend of decreasing LOS and increased return to the operating room for patients with laparoscopic surgery. Laparoscopic Graham patch repair of peptic ulcers significantly increased, although open repair still constitutes the majority of the cases. Despite Graham patch repair being utilized on a healthier patient population, morbidity and mortality for laparoscopic repair have remained unchanged. Postoperative morbidity and mortality for open surgery have increased. This indicates that laparoscopic repair is more commonly utilized for low- or medium risk patients, leaving an increasingly sick patient population selected to open repair.

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

2016 ◽  
pp. 99-105
Author(s):  
Huu Tri Nguyen ◽  
Loc Le ◽  
Doàn Van Phu Nguyen ◽  
Nhu Thanh Dang ◽  
Thanh Phuc Nguyen
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Surgery ◽  
Correlation Coefficient ◽  
Open Surgery ◽  
Operative Time ◽  
Single Port ◽  
Time Correlation ◽  
Patch Repair ◽  
Perforated Duodenal Ulcer ◽  
Conversion To Open Surgery

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

scholarly journals Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

2018 ◽  
Vol 5 (3) ◽  
pp. 927
Author(s):  
Vaibhav Srivastava ◽  
Gyanendra Singh ◽  
Santosh K. Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Open Surgery ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Peptic Ulcers ◽  
Omental Patch ◽  
Operative Complications ◽  
Repair Group

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

scholarly journals Laparoscopic and open repair of perforated peptic ulcer

2017 ◽  
Vol 4 (6) ◽  
pp. 2022
Author(s):  
Ahmed Abdel Monem Ibrahim ◽  
Backeet Turkeyev ◽  
Mohammad Mahmood Al Alkatary
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Perforated Peptic Ulcer ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Current Evidence ◽  
Open Approach

Background: The study included patients diagnosed as perforated peptic ulcer. Outcomes are assessed by mortality and morbidity rate, operation time and hospital length of stay.Methods: On the period from January 2013 to December 2014 a total of 71 patients were operated in both facilities: 37 patients in Dubai hospital and 34 in Mafraq Hospital. Open repair with omental patch done in 34 patients (47.9%) and laparoscopically in 37 patients (52.1%). No cases of laparoscopy converted to laparotomy.Results: The data demonstrates homogeneous results for the outcome variables of morbidity and complications, while operation time and hospital length of stay differ significantly. Statistical significance could not be reached for any of these variables, although odd ratios were consistently in favour of the laparoscopic repair. Similarly, the laparoscopic approach resulted in a lower rate of minor complications (10% vs. 23%). Total lengths of stay post open repair made of 4.2±1.2 days, after laparoscopic repair 3.6±0.9 days. At the same time there were observed longer operating times for laparoscopic repair of PPU which constituted 62±10.6 minutes whereas open repair took only 45±12.9 minutes. Peritoneal lavage has been a factor of prolonged duration of laparoscopic surgery.Conclusions: Laparoscopic repair of a perforated peptic ulcer is an amenable and feasible technique within the hands of experienced laparoscopic surgeon. Current evidence does not clearly demonstrate the advantages of laparoscopic versus open repair. Growing interest in the laparoscopic approach may encourage the design of additional randomized trials to analyze its efficacy compared with the open approach.

scholarly journals Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality

10.19082/2543 ◽  
2016 ◽  
Vol 8 (6) ◽  
pp. 2543-2543 ◽  
Author(s):  
Mahdi Alemrajabi ◽  
Saeed Safari ◽  
Adnan Tizmaghz ◽  
Fatemeh Alemrajabi ◽  
Ghazaal Shabestanipour
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality

Custom-made Stent Grafts for the Treatment of Pseudoaneurysms after Childhood Coarctation Surgery

2018 ◽  
Vol 67 (01) ◽  
pp. 050-054 ◽  
Author(s):  
Andreas Hornung ◽  
Michael Hofbeck ◽  
Christian Schlensak ◽  
Mario Lescan
Keyword(s):  
Endovascular Repair ◽  
Complete Resolution ◽  
Open Surgery ◽  
Open Repair ◽  
Clinical Success ◽  
Coarctation Of The Aorta ◽  
Morbidity And Mortality ◽  
Thoracic Cavity ◽  
Stent Grafts ◽  
Custom Made

Background Post-coarctation of the aorta (CoA) pseudoaneurysms is a complication of open repair. Thoracic endovascular repair (TEVAR) is feasible but complicated by proximity to the supra-aortic trunks and severe arch angulation. Methods We describe three cases of post-CoA pseudoaneurysms treated with custom-made Relay stent grafts (Vascutek, Scotland). Results Technical and clinical success was achieved in all three cases with no mortality, morbidity, endoleaks, or complications. In all three, pseudoaneurysm sac shrinkage was observed at the follow-ups; in one case, there was complete resolution. Conclusion Redo open surgery is challenging because of adhesions of the thoracic cavity and associated morbidity and mortality. TEVAR is less invasive and offers fewer complications. Custom-made modifications overcome difficult anatomies including short landing zones and diameter variability.

scholarly journals A prospective observational study on feasibility of laparoscopic perforation repair in patients presenting with intestinal perforation at a tertiary care superspeciality hospital in Chhattisgarh

2020 ◽  
Vol 7 (5) ◽  
pp. 1597
Author(s):  
Deepak Taneja ◽  
Akash Gupta ◽  
Sandeep Dave ◽  
Siddharth Tamaskar
Keyword(s):  
Laparoscopic Repair ◽  
Bowel Perforation ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Suture Repair ◽  
High Morbidity ◽  
Care Hospital ◽  
Perioperative Morbidity ◽  
Male Predominance ◽  
Early Return

Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically  significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality. 

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

2020 ◽  
pp. 153857442097647
Author(s):  
António Pereira-Neves ◽  
Ricardo Gouveia ◽  
Marina Dias-Neto ◽  
Luís Duarte-Gamas ◽  
João Rocha-Neves ◽  
...  
Keyword(s):  
Open Surgery ◽  
Innominate Artery ◽  
Good Alternative ◽  
High Energy ◽  
Morbidity And Mortality ◽  
Blunt Injury ◽  
Stent Patency ◽  
Perioperative Morbidity ◽  
Pseudoaneurysm Formation ◽  
Brachiocephalic Trunk

Innominate artery (IA) injury is a rare entity with most patients dying before reaching the hospital. While open surgery remains the standard treatment, the endovascular approach is attractive as it may reduce perioperative morbidity and mortality. We report a case of IA blunt injury extending to the subclavian artery with pseudoaneurysm formation successfully treated with covered stenting of IA and its bifurcation. A 49-year-old male was admitted after suffering multiple trauma due to a high energy impact motorcycle crash. In the emergency room, the patient was hypotensive with a Glasgow coma score of 15. On physical examination, he had right peri-orbital ecchymosis, left otorrhagia and an open patella fracture. The computed tomographic angiography (CTA) revealed enlargement of the mediastinum and a 29 mm pseudoaneurysm involving the right brachiocephalic trunk and its bifurcation. Under general anesthesia, a covered balloon-expandable stent (CBES) was then placed in the IA followed by kissing stent of its bifurcation with an additional 2 covered balloon-expandable stents. Final subtraction angiography demonstrated complete pseudoaneurysm exclusion and stent patency without additional complications. No neurologic deficits or other intervention-related complications were found in the postoperative period. At 10 months follow-up, the patient remained asymptomatic and with palpable distal pulses. Endovascular management of IA injury may provide a good alternative to open surgery with low perioperative morbidity and mortality.

scholarly journals Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
A. Anagnostopoulos ◽  
S. Mitra ◽  
B. Decruze ◽  
R. Macdonald ◽  
J. Kirwan
Keyword(s):  
Laparoscopic Surgery ◽  
Radical Hysterectomy ◽  
Hospital Cost ◽  
Open Surgery ◽  
Enhanced Recovery ◽  
Bladder Function ◽  
Retrospective Case ◽  
Laparoscopic Radical Hysterectomy ◽  
Perioperative Morbidity ◽  
Significant Difference

Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.

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