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. 2023 Jul;37(7):5137-5149.
doi: 10.1007/s00464-023-09998-5. Epub 2023 Mar 21.

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Gianluca Costa #  1 , Pietro Fransvea #  2 , Luca Lepre  3 , Gianluca Liotta  4 , Gianluca Mazzoni  5 , Alan Biloslavo  6 , Valentina Bianchi  7 , Savino Occhionorelli  8   9 , Alessandro Costa  10 , Gabriele Sganga  7 ; FACS on behalf of the IGo-GIPS study group
Collaborators, Affiliations

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Gianluca Costa et al. Surg Endosc. 2023 Jul.

Abstract

Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure.

Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared.

Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2.

Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.

Keywords: Laparoscopic approach; Perforated peptic ulcer; Surgical treatment.

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Conflict of interest statement

Drs. Gianluca Costa, Pietro Fransvea, Luca Lepre, Gianluca Liotta, Gianluca Mazzoni, Alan Biloslavo, Valentina Bianchi, Savino Occhionorelli, Alessandro Costa, Gabriele Sganga and the IGo-GIPS study group have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of clinical study design. (PSM propensity score matching, Lap. laparoscopy)
Fig. 2
Fig. 2
Comparison of receiver-operating characteristic (ROC) curve of MPI, Boey score, PULP score and Jabalpur score for overall morbidity
Fig. 3
Fig. 3
Comparison of receiver-operating characteristic (ROC) curve of MPI, Boey score, PULP score and Jabalpur score for mortality
See this image and copyright information in PMC

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