Risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Li ¹ ,  ZHUANG Wen ²

1. Department of General Surgery, Chengdu 5th Hospital, Chengdu 611130, P.R.China;
2. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

ZHUANG Wen, Email: 102158807@qq.com

Keywords：

perforated peptic ulcer; laparoscope; conversion to open surgery; risk factor; complications

DOI：

10.7507/1007-9424.201606048

Video：

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Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.

Citation： ZHOULi, ZHUANGWen. Risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 195-200. doi: 10.7507/1007-9424.201606048 Copy

1.	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(1): 51-58.
2.	Mouret P, François Y, Vignal J,et al. Laparoscopic treatment of perforated peptic ulcer. Br J Surg, 1990, 77(9): 1006.
3.	Bertleff MJ, Halm JA, Bemelman WA,et al. Randomized clinical trial of laparoscopicversus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg, 2009, 33(7): 1368-1373.
4.	Siu WT, Leong HT, Law BK,et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg, 2002, 235(3): 313-319.
5.	Bhogal RH, Athwal R, Durkin D,et al. Comparison between open and laparoscopic repair of perforated peptic ulcer disease. World J Surg, 2008, 32(11): 2371-2374.
6.	Sanabria AE, Morales CH, Villegas MI. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev, 2013, (2): CD004778.
7.	Zhou C, Wang W, Wang J,et al. An updated meta-analysis of laparoscopicversus open repair for perforated peptic ulcer. Sci Rep, 2015, 5: 13976.
8.	Lau H. Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc, 2004, 18(7): 1013-1021.
9.	Møller MH, Adamsen S, Wøjdemann M,et al. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol, 2009, 44(1): 15-22.
10.	Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11.	Sartelli M, Viale P, Catena F,et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg, 2013, 8(1): 3.
12.	Sauerland S, Agresta F, Bergamaschi R,et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc, 2006, 20(1): 14-29.
13.	Thorsen K, Glomsaker TB, von Meer A,et al. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg, 2011, 15(8): 1329-1335.
14.	Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg, 2014, 101(1): e51-e64.
15.	Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg, 2005, 29(10): 1299-1310.
16.	Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg, 2009, 33(1): 80-85.
17.	Guadagni S, Cengeli I, Galatioto C,et al. Laparoscopic repair of perforated peptic ulcer: single-center results. Surg Endosc, 2014, 28(8): 2302-2308.
18.	Bosma E, Pullens MJ, de Vries J,et al. The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system. Colorectal Dis, 2015, 18(6): 594-602.
19.	Baba Y, Yoshida N, Shigaki H,et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg, 2016, 264(2): 305-311.
20.	Wilhelmsen M, Møller MH, Rosenstock S. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort. Br J Surg, 2015, 102(4): 382-387.
21.	Møller MH, Adamsen S, Thomsen RW,et al. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol, 2010, 45(7-8): 785-805.
22.	Katkhouda N, Mavor E, Mason RJ,et al. Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg, 1999, 134(8): 845-848.
23.	Lee FY, Leung KL, Lai PB,et al. Selection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg, 2001, 88(1): 133-136.
24.	Lee FY, Leung KL, Lai BS,et al. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg, 2001, 136(1): 90-94.
25.	Lunevicius R, Morkevicius M. Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value. Langenbecks Arch Surg, 2005, 390(8): 413-420.

1. 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(1): 51-58.
2. Mouret P, François Y, Vignal J,et al. Laparoscopic treatment of perforated peptic ulcer. Br J Surg, 1990, 77(9): 1006.
3. Bertleff MJ, Halm JA, Bemelman WA,et al. Randomized clinical trial of laparoscopicversus open repair of the perforated peptic ulcer: the LAMA Trial. World J Surg, 2009, 33(7): 1368-1373.
4. Siu WT, Leong HT, Law BK,et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg, 2002, 235(3): 313-319.
5. Bhogal RH, Athwal R, Durkin D,et al. Comparison between open and laparoscopic repair of perforated peptic ulcer disease. World J Surg, 2008, 32(11): 2371-2374.
6. Sanabria AE, Morales CH, Villegas MI. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev, 2013, (2): CD004778.
7. Zhou C, Wang W, Wang J,et al. An updated meta-analysis of laparoscopicversus open repair for perforated peptic ulcer. Sci Rep, 2015, 5: 13976.
8. Lau H. Laparoscopic repair of perforated peptic ulcer: a meta-analysis. Surg Endosc, 2004, 18(7): 1013-1021.
9. Møller MH, Adamsen S, Wøjdemann M,et al. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol, 2009, 44(1): 15-22.
10. Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11. Sartelli M, Viale P, Catena F,et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg, 2013, 8(1): 3.
12. Sauerland S, Agresta F, Bergamaschi R,et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc, 2006, 20(1): 14-29.
13. Thorsen K, Glomsaker TB, von Meer A,et al. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg, 2011, 15(8): 1329-1335.
14. Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg, 2014, 101(1): e51-e64.
15. Lunevicius R, Morkevicius M. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer. World J Surg, 2005, 29(10): 1299-1310.
16. Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg, 2009, 33(1): 80-85.
17. Guadagni S, Cengeli I, Galatioto C,et al. Laparoscopic repair of perforated peptic ulcer: single-center results. Surg Endosc, 2014, 28(8): 2302-2308.
18. Bosma E, Pullens MJ, de Vries J,et al. The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system. Colorectal Dis, 2015, 18(6): 594-602.
19. Baba Y, Yoshida N, Shigaki H,et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg, 2016, 264(2): 305-311.
20. Wilhelmsen M, Møller MH, Rosenstock S. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort. Br J Surg, 2015, 102(4): 382-387.
21. Møller MH, Adamsen S, Thomsen RW,et al. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol, 2010, 45(7-8): 785-805.
22. Katkhouda N, Mavor E, Mason RJ,et al. Laparoscopic repair of perforated duodenal ulcers: outcome and efficacy in 30 consecutive patients. Arch Surg, 1999, 134(8): 845-848.
23. Lee FY, Leung KL, Lai PB,et al. Selection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg, 2001, 88(1): 133-136.
24. Lee FY, Leung KL, Lai BS,et al. Predicting mortality and morbidity of patients operated on for perforated peptic ulcers. Arch Surg, 2001, 136(1): 90-94.
25. Lunevicius R, Morkevicius M. Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value. Langenbecks Arch Surg, 2005, 390(8): 413-420.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer

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