Ontology type: schema:ScholarlyArticle
2016-09
AUTHORSMarkus K. Muller, Simon Wrann, Jeannette Widmer, Jennifer Klasen, Markus Weber, Dieter Hahnloser
ABSTRACTOBJECTIVE: The surgical treatment for perforated peptic ulcers can be safely performed laparoscopically. The aim of the study was to define simple predictive factors for conversion and septic complications. METHODS: This retrospective case-control study analyzed patients treated with either laparoscopic surgery or laparotomy for perforated peptic ulcers. RESULTS: A total of 71 patients were analyzed. Laparoscopically operated patients had a shorter hospital stay (13.7 vs. 15.1 days). In an intention-to-treat analysis, patients with conversion to open surgery (analyzed as subgroup from laparoscopic approach group) showed no prolonged hospital stay (15.3 days) compared to patients with a primary open approach. Complication and mortality rates were not different between the groups. The statistical analysis identified four intraoperative risk factors for conversion: Mannheim peritonitis index (MPI) > 21 (p = 0.02), generalized peritonitis (p = 0.04), adhesions, and perforations located in a region other than the duodenal anterior wall. We found seven predictive factors for septic complications: age >70 (p = 0.02), cardiopulmonary disease (p = 0.04), ASA > 3 (p = 0.002), CRP > 100 (p = 0.005), duration of symptoms >24 h (p = 0.02), MPI > 21(p = 0.008), and generalized peritonitis (p = 0.02). CONCLUSION: Our data suggest that a primary laparoscopic approach has no disadvantages. Factors necessitating conversions emerged during the procedure inhibiting a preoperative selection. Factors suggesting imminent septic complications can be assessed preoperatively. An assessment of the proposed parameters may help optimize the management of possible septic complications. More... »
PAGES2186-2193
http://scigraph.springernature.com/pub.10.1007/s00268-016-3516-z
DOIhttp://dx.doi.org/10.1007/s00268-016-3516-z
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PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/27119515
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"description": "OBJECTIVE: The surgical treatment for perforated peptic ulcers can be safely performed laparoscopically. The aim of the study was to define simple predictive factors for conversion and septic complications.\nMETHODS: This retrospective case-control study analyzed patients treated with either laparoscopic surgery or laparotomy for perforated peptic ulcers.\nRESULTS: A total of 71 patients were analyzed. Laparoscopically operated patients had a shorter hospital stay (13.7 vs. 15.1\u00a0days). In an intention-to-treat analysis, patients with conversion to open surgery (analyzed as subgroup from laparoscopic approach group) showed no prolonged hospital stay (15.3\u00a0days) compared to patients with a primary open approach. Complication and mortality rates were not different between the groups. The statistical analysis identified four intraoperative risk factors for conversion: Mannheim peritonitis index (MPI)\u00a0>\u00a021 (p\u00a0=\u00a00.02), generalized peritonitis (p\u00a0=\u00a00.04), adhesions, and perforations located in a region other than the duodenal anterior wall. We found seven predictive factors for septic complications: age >70 (p\u00a0=\u00a00.02), cardiopulmonary disease (p\u00a0=\u00a00.04), ASA\u00a0>\u00a03 (p\u00a0=\u00a00.002), CRP\u00a0>\u00a0100 (p\u00a0=\u00a00.005), duration of symptoms >24\u00a0h (p\u00a0=\u00a00.02), MPI\u00a0>\u00a021(p\u00a0=\u00a00.008), and generalized peritonitis (p\u00a0=\u00a00.02).\nCONCLUSION: Our data suggest that a primary laparoscopic approach has no disadvantages. Factors necessitating conversions emerged during the procedure inhibiting a preoperative selection. Factors suggesting imminent septic complications can be assessed preoperatively. An assessment of the proposed parameters may help optimize the management of possible septic complications.",
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