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Surgical Endoscopy

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Open Access 01-06-2010 | Review

Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

Authors: Mariëtta J. O. E. Bertleff, Johan F. Lange

Published in: Surgical Endoscopy | Issue 6/2010

Abstract

Background

Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense.

Methods

An electronic literature search was done by using PubMed and EMBASE databases. Relevant papers written between January 1989 and May 2009 were selected and scored according to Effective Public Health Practice Project guidelines.

Results

Data were extracted from 56 papers, as summarized in Tables 1–7. The overall conversion rate for laparoscopic correction of perforated peptic ulcer was 12.4%, with main reason for conversion being the diameter of perforation. Patients presenting with PPU were predominantly men (79%), with an average age of 48 years. One-third had a history of peptic ulcer disease, and one-fifth took nonsteroidal anti-inflammatory drugs (NSAIDs). Only 7% presented with shock at admission. There seems to be no consensus on the perfect setup for surgery and/or operating technique. In the laparoscopic groups, operating time was significant longer and incidence of recurrent leakage at the repair site was higher. Nonetheless there was significant less postoperative pain, lower morbidity, less mortality, and shorter hospital stay.

Conclusion

There are good arguments that laparoscopic correction of PPU should be first treatment of choice. A Boey score of 3, age over 70 years, and symptoms persisting longer than 24 h are associated with higher morbidity and mortality and should be considered contraindications for laparoscopic intervention.

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Title: Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature
Authors: Mariëtta J. O. E. Bertleff
Johan F. Lange
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0765-z

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Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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