Main Article Content
The incidence of perforated peptic ulcers has decreased during the last decades but the optimal treatment for these patients remains controversial. At the same time, a laparoscopic approach to this condition has been adopted by an increased number of surgeons.
Therefore, this study wants to evaluate the postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in one Italian center with extensive experience in laparoscopic surgery.
This retrospective study includes 94 patients who were operated for perforated peptic ulcer peritonitis at “St. Orsola Hospital - Emergency Surgery Unit - University of Bologna” from May 2014 to December 2019. The patients’ charts were reviewed for demographics, surgical procedure, complications, and short-term outcomes.
The diagnosis was made clinically and confirmed by the presence of gas under diaphragm on abdominal X-ray. All patients underwent primary suture repair with or without omentopexy. Boey score 0 or 1 was found in 66 (70%) patients, Boey 2 or 3 in 28 (30%) patients. The operative time was between 35 and 255 minutes, with a mean of 93 minutes. The overall median hospital stay was 9.5 (1-60) days. Post-operative complications occurred in 19 (20%) patients and 18 (19%) patients died.
Perforated peptic ulcer is a severe condition that requires early hospital admission and immediate surgery. Laparoscopy in experienced centers and for selected patients is safe, associated with optimal outcomes and should be the preferred approach.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
- Bae S, Shim KN, Kim N, Kang JM, Kim DS, Kim KM, et al. Incidence and short-term mortality from perforated peptic ulcer in Korea: a population-based study. J Epidemiol. 2012;22:508-16.
- Hermansson M, Ekedahl A, Ranstam J, Zilling T. Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002. BMC Gastroenterol. 2009;9:25.
- Lassen A, Hallas J, Schaffalitzky de Muckadell OB. Complicated and uncomplicated peptic ulcers in a Danish county 1993-2002: a population-based cohort study. Am J Gastroenterol. 2006;101:945-53.
- Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg. 2000;24:277-83.
- Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27:161-9.
- Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251:51-8.
- Soreide K, Sarr MG, Soreide JA. Pyloroplasty for benign gastric outlet obstruction--indications and techniques. Scand J Surg. 2006;95:11-6.
- Dongo AE, Uhunmwagho O, Kesieme EB, Eluehike SU, Alufohai EF. A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria. Int Sch Res Notices. 2017;2017:8375398.
- Thorsen K, Soreide JA, Kvaloy JT, Glomsaker T, Soreide K. Epidemiology of perforated peptic ulcer: age- and gender-adjusted analysis of incidence and mortality. World J Gastroenterol. 2013;19:347-54.
- Hodnett RM, Gonzalez F, Lee WC, Nance FC, Deboisblanc R. The need for definitive therapy in the management of perforated gastric ulcers. Review of 202 cases. Ann Surg. 1989;209:36-9.
- Horowitz J, Kukora JS, Ritchie WP, Jr. All perforated ulcers are not alike. Ann Surg. 1989;209:693-6; discussion 6-7.
- Lanng C, Palnaes Hansen C, Christensen A, Thagaard CS, Lassen M, Klaerke A, et al. Perforated gastric ulcer. Br J Surg. 1988;75:758-9.
- Ergul E, Gozetlik EO. Emergency spontaneous gastric perforations: ulcus versus cancer. Langenbecks Arch Surg. 2009;394:643-6.
- Muller MK, Wrann S, Widmer J, Klasen J, Weber M, Hahnloser D. Perforated Peptic Ulcer Repair: Factors Predicting Conversion in Laparoscopy and Postoperative Septic Complications. World J Surg. 2016;40:2186-93.
- Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9:1-12.
- Schulte-Hermes M, Klein-Wiele O, Vorpahl M, Seyfarth M. Acute tension pneumopericardium due to perforated gastric ulcer without diagnostic radiographic findings 72 h before perforation. J Cardiol Cases. 2018;18:201-3.
- Bhattacharjee HK, Misra MC, Kumar S, Bansal VK. Duodenal perforation following blunt abdominal trauma. J Emerg Trauma Shock. 2011;4:514-7.
- Milosavljevic T, Kostic-Milosavljevic M, Jovanovic I, Krstic M. Complications of peptic ulcer disease. Dig Dis. 2011;29:491-3.
- Sarosi GA, Jr., Jaiswal KR, Nwariaku FE, Asolati M, Fleming JB, Anthony T. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190:775-9.
- Moller MH, Adamsen S, Thomsen RW, Moller AM, Peptic Ulcer Perforation trial g. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98:802-10.
- Nakano A, Bendix J, Adamsen S, Buck D, Mainz J, Bartels P, et al. 30-days mortality in patients with perforated peptic ulcer: A national audit. Risk Manag Healthc Policy. 2008;1:31-8.
- Towfigh S, Chandler C, Hines OJ, McFadden DW. Outcomes from peptic ulcer surgery have not benefited from advances in medical therapy. Am Surg. 2002;68:385-9.
- Lee CW, Sarosi GA, Jr. Emergency ulcer surgery. Surg Clin North Am. 2011;91:1001-13.
- Byrge N, Barton RG, Enniss TM, Nirula R. Laparoscopic versus open repair of perforated gastroduodenal ulcer: a National Surgical Quality Improvement Program analysis. Am J Surg. 2013;206:957-62; discussion 62-3.
- Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22-6.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
- Baron JH. Paintress, princess and physician's paramour: poison or perforation? J R Soc Med. 1998;91:213-6.
- Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15.
- Bali RS, Verma S, Agarwal PN, Singh R, Talwar N. Perforation peritonitis and the developing world. ISRN Surg. 2014;2014:105492.
- Kutlu OC, Garcia S, Dissanaike S. The successful use of simple tube duodenostomy in large duodenal perforations from varied etiologies. Int J Surg Case Rep. 2013;4:279-82.
- Gurusamy KS, Pallari E. Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database Syst Rev. 2016;3:CD011523.
- Sanabria A, Villegas MI, Morales Uribe CH. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev. 2013:CD004778.
- Camera L, Calabrese M, Romeo V, Scordino F, Mainenti PP, Clemente M, et al. Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report. J Med Case Rep. 2013;7:257.
- Pohl D, Schmutz G, Plitzko G, Kroll D, Nett P, Borbely Y. Perforated duodenal ulcers after Roux-Y Gastric Bypass. Am J Emerg Med. 2018;36:1525 e1- e3.
- Tan S, Wu G, Zhuang Q, Xi Q, Meng Q, Jiang Y, et al. Laparoscopic versus open repair for perforated peptic ulcer: A meta analysis of randomized controlled trials. Int J Surg. 2016;33 Pt A:124-32.
- Khan SH, Aziz SH, Ul-Haq MI. Perforated peptic ulcer: a review of 36 cases. Professional Med J. 2011:124-7.
- Lee FY, Leung KL, Lai BS, Ng SS, Dexter S, Lau WY. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg. 2001;136:90-4.
- Teoh AY, Chiu PW, Kok AS, Wong SK, Ng EK. The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer. World J Surg. 2015;39:740-5.
- Lau H. Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc. 2004;18:1013-21.