Comparison between Laparoscopic and Open Repair for Perforated Peptic Ulcer Disease in the Elderly_West China Medical Journal

Authors：

 ZHOULi ^1,2 ,  ZHUANGWen ¹

1. Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Gastrointestinal Surgery, the Fi h People's Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;

Corresponding author：

ZHUANGWen, Email: 102158807@qq.com

Keywords：

Laparoscopic; Open repair; Peptic ulcer; Elderly patients

DOI：

10.7507/1002-0179.20150538

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate whether laparoscopic repair for perforated peptic ulcer o ers elderly patients an improved outcome compared with conventional open surgery. Methods From May 2008 to December 2013, clinical data of 163 elderly patients ( ≥ 60 years) who underwent laparoscopic or open repair of perforated peptic ulcer disease were analyzed retrospectively in our hospital. Ninety-one patients received laparoscopic repair and 72 received conventional open repair. The primary end points that were evaluated were total operative time, searching time, nasogastric tube utilization, intravenous fluid requirement, total time of abdominal drainage and urinary catheter usage, time taken to return to normal gastrointestinal motility, percentage of intravenous/intramuscular opiate use, off-bed time, and total in-patient hospital stay. The second end points were morbidity. Results There was a significant diTherence in total operative time in patients who had undergone laparoscopic repair and open repair [(67.9±3.6) minutes vs. (97.8±5.2) minutes]. There was a significant decrease in the time that the nasogastric tube (2.1 days vs. 3.1 days), urinary catheter (2.3 days vs. 3.7 days) and abdominal drain (2.2 days vs. 3.8 days) were required during the postoperative period. Patients who had undergone laparoscopic repair also required less intravenous fluids (2.4 days vs. 4.1 days) and returned to normal gastrointestinal motility [(32.1±1.5) hours vs. (58.4±4.8) hours] and off-bed time significantly earlier than those who had undergone open repair (2.1 days vs. 3.5 days). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (4.7% vs. 45.6%). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (4.1 days vs. 5.3 days). Moreover, morbidity of laparoscopic repair was much lower than open repair (3.3% vs. 16.7%). Conclusion Laparoscopic repair is a viable and safe surgical option for elderly patients with perforated peptic ulcer disease and should be considered for all patients.

Citation： ZHOULi, ZHUANGWen. Comparison between Laparoscopic and Open Repair for Perforated Peptic Ulcer Disease in the Elderly. West China Medical Journal, 2015, 30(10): 1873-1876. doi: 10.7507/1002-0179.20150538 Copy

1.	Koo J, Ngan YK, Lam SK. Trends in hospital admission, perforation and mortality of peptic ulcer in Hong Kong from 1970 to 1980[J]. Gastroenterology, 1983, 84(6):1558-1562.
2.	Gunshefski L, Flancbaum L, Brolin RE, et al. Changing patterns in perforated peptic ulcer disease[J]. Am Surg, 1990, 56(4):270-274.
3.	Tsugawa K, Koyanagi N, Hashizume M, et al. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age[J]. Hepatogastroenterology, 2001, 48(37):156-162.
4.	Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer:first choice? A review of literature[J]. Surg Endosc, 2010, 24(6):1231-1239.
5.	Bertleff MJ, Halm JA, Bemelman WA, et al. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer:the LAMA Trial[J]. World J Surg, 2009, 33(7):1368-1373.
6.	丁杰, 廖国庆, 张忠民, 等.腹腔镜与开腹消化性溃疡穿孔修补术比较的Meta分析[J]. 中华胃肠外科杂志, 2011, 14(10):785-789.
7.	Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer[J]. World J Surg, 2005, 29(10):1299-1310.
8.	Siu WT, Leong HT, Law BK, et al. Laparoscopic repair for perforated peptic ulcer:a randomized controlled trial[J]. Ann Surg, 2002, 235(3):313-319.
9.	Katkhouda N, Mavor E, Mason RJ, et al. Laparoscopic repair of perforated duodenal ulcers:outcome and efficacy in 30 consecutive patients[J]. Arch Surg, 1999, 134(8):845-848; discussion 849-850.
10.	Lau WY, Leung KL, Zhu XL, et al. Laparoscopic repair of perforated peptic ulcer[J]. Br J Surg, 1995, 82(6):814-816.
11.	Bhogal RH, Athwal R, Durkin D, et al. Comparison between open and laparoscopic repair of perforated peptic ulcer disease[J]. World J Surg, 2008, 32(11):2371-2374.
12.	Avital S, Itah R, Szomstein S, et al. Correlation of CO₂ pneumoperitoneal pressures between rodents and humans[J]. Surg Endosc, 2009, 23(1):50-54.
13.	Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum[J]. J Gastrointest Surg, 2009, 13(5):1009-1016.
14.	Li LW, Zhang W, Ai YQ, et al. Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration[J]. J Int Med Res, 2013, 41(3):889-894.
15.	Frazee RC, Roberts JW, Okeson GC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function[J]. Ann Surg, 1991, 213(6):651-653; discussion 653-654.
16.	Staehr-Rye AK, Rasmussen LS, Rosenberg J, et al. Minimal impairment in pulmonary function following laparoscopic surgery[J]. Acta Anaesthesiol Scand, 2014, 58(2):198-205.

1. Koo J, Ngan YK, Lam SK. Trends in hospital admission, perforation and mortality of peptic ulcer in Hong Kong from 1970 to 1980[J]. Gastroenterology, 1983, 84(6):1558-1562.
2. Gunshefski L, Flancbaum L, Brolin RE, et al. Changing patterns in perforated peptic ulcer disease[J]. Am Surg, 1990, 56(4):270-274.
3. Tsugawa K, Koyanagi N, Hashizume M, et al. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age[J]. Hepatogastroenterology, 2001, 48(37):156-162.
4. Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer:first choice? A review of literature[J]. Surg Endosc, 2010, 24(6):1231-1239.
5. Bertleff MJ, Halm JA, Bemelman WA, et al. Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer:the LAMA Trial[J]. World J Surg, 2009, 33(7):1368-1373.
6. 丁杰, 廖国庆, 张忠民, 等.腹腔镜与开腹消化性溃疡穿孔修补术比较的Meta分析[J]. 中华胃肠外科杂志, 2011, 14(10):785-789.
7. Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer[J]. World J Surg, 2005, 29(10):1299-1310.
8. Siu WT, Leong HT, Law BK, et al. Laparoscopic repair for perforated peptic ulcer:a randomized controlled trial[J]. Ann Surg, 2002, 235(3):313-319.
9. Katkhouda N, Mavor E, Mason RJ, et al. Laparoscopic repair of perforated duodenal ulcers:outcome and efficacy in 30 consecutive patients[J]. Arch Surg, 1999, 134(8):845-848; discussion 849-850.
10. Lau WY, Leung KL, Zhu XL, et al. Laparoscopic repair of perforated peptic ulcer[J]. Br J Surg, 1995, 82(6):814-816.
11. Bhogal RH, Athwal R, Durkin D, et al. Comparison between open and laparoscopic repair of perforated peptic ulcer disease[J]. World J Surg, 2008, 32(11):2371-2374.
12. Avital S, Itah R, Szomstein S, et al. Correlation of CO₂ pneumoperitoneal pressures between rodents and humans[J]. Surg Endosc, 2009, 23(1):50-54.
13. Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum[J]. J Gastrointest Surg, 2009, 13(5):1009-1016.
14. Li LW, Zhang W, Ai YQ, et al. Influence of laparoscopic carbon dioxide pneumoperitoneum on neonate circulation and respiration[J]. J Int Med Res, 2013, 41(3):889-894.
15. Frazee RC, Roberts JW, Okeson GC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function[J]. Ann Surg, 1991, 213(6):651-653; discussion 653-654.
16. Staehr-Rye AK, Rasmussen LS, Rosenberg J, et al. Minimal impairment in pulmonary function following laparoscopic surgery[J]. Acta Anaesthesiol Scand, 2014, 58(2):198-205.

Previous Article
万古霉素过敏致剥脱性皮炎的护理体会一例
Next Article
A Randomized Controlled Trial on Holmium Laser Resection and Plasmakinetic Resection of Bladder Tumors

West China Medical Journal

Comparison between Laparoscopic and Open Repair for Perforated Peptic Ulcer Disease in the Elderly

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content