Citation Information :
El-Ghazzawy O, Massier C, Walsh W, North D, Kondajji A, Chao T. Use of Laparoscopic vs Open Repair for Perforated Peptic Ulcers is Determined by Surgeon Experience. World J Lap Surg 2022; 15 (1):40-46.
Introduction: The incidence of perforated peptic ulcers (PPU) has decreased with effective medical treatment such that surgical repair has become a relatively infrequent procedure. We hypothesized that the surgeon's experience and the patient's clinical presentation are the most influential factors that determined the surgical approach.
Methods: A retrospective chart review of PPU repairs in the last 10 years was performed to collect surgeon demographics, patient clinical condition, comorbidities, and whether surgeries were done at a regional or tertiary site. Outcome variables included length of stay, complications, and readmissions. A multivariate analysis was used to establish statistically significant correlations.
Results: Of 219 operations for PPU, 49 were started laparoscopic (23.2%), 12 were converted to open (5.7%), and 162 were performed open (76.5%). The open and laparoscopic cohorts were similar without statistical difference between the groups in terms of age, sex, comorbidities, previous steroid use, NSAID, and anticoagulation use. Surgeons who attempted laparoscopy were more likely to have completed MIS fellowship (60.2%, p <0.001). The patients who had laparoscopic repair had a significantly shorter length of stay (8.5 vs 12.6 days; p <0.01). The patients who had an open repair had slightly more complications (18.4 vs 5.4%), readmissions (5.2 vs 2.7%), and hospital mortality (12.1 vs 5.4%) than their laparoscopically treated counterparts, although none was statistically significant.
Conclusion: Surgeons who completed a minimally invasive fellowship were more likely to perform a laparoscopic repair of perforated peptic ulcer, regardless of the patient's clinical presentation, comorbid conditions, and demographics. Patients who underwent laparoscopic repair had a significantly shorter LOS. Educational efforts directed toward community surgeons who do not have prior MIS training are likely to benefit patients with PUD by increasing access to laparoscopic surgery for PPU.
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