Retrospective Study of Therapeutic Limits to Laparoscopic Omental Patch Repair for Perforated Gastroduodenal Peptic Ulcer

Takanori Kyokane, Shinsuke Iyomasa, Naoki Sawasaki, Yuichiro Tojima, Hidenari Goto, Taihei Oshiro, Hiroyuki Watanabe, Masahiro Tanaka, Takehiro Takagi and Masao Matsuda

Department of Surgery, Chukyo Hospital

Introduction: The therapeutic limits to laparoscopic omental patch repair (LOPR) for perforated gastroduodenal peptic ulcer are unclear, so we conducted a clinical study to clarify factors for converting from LOPR to open surgery (OS). Methods: We reviewed 64 cases of LOPR for gastric (n=16) and duodenal (n=48) peptic ulcer perforation from January 2000 to March 2008 and classified into group A, conversion some days after LOPR, group B, LOPR alone, and group C, conversion during LOPR. Results: A comparison of groups A and B showed the following factors to be significantly associated with LOPR conversion to OS: the maximum fluid collection (MFC) around the liver in abdominal computed tomography (CT) was ≥15 mm and the perforation diameter was ≥10 mm. When either factor involved 15 mm or more, cases were included in group A. Other clinical factors, such as age, perforation site, physical abdominal examination findings, body temperature, time from onset, serum CRP, and the surgeon, were not significant in conversion. Groups B and C showed no significant differences in morbidity, day of dietary resumption, or hospital stay. Morbidity was high in group A, resulting in a longer hospital stay than for group B. Conclusions: The two important factors in converting from LOPR to OS were MFC around the liver in abdominal CT and perforation size. These provide us with important information on selecting the appropriate surgical procedure, and these conversion factors should be taken into account at LOPR or before surgery to reduce morbidity and shorten the hospital stay.

Key words
laparoscopic omental patch repair, gastroduodenal ulcer, perforation, perforated peptic ulcer, conversion factor

Reprint requests
Takanori Kyokane Department of Surgery, Fukuroi Municipal Hospital
2515-1 Kunou, Fukuroi, 437-0061 JAPAN

Accepted
May 27, 2009

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