Selection of patients for laparoscopic repair of perforated peptic ulcer.
BACKGROUND
Although randomized and non-randomized studies have evaluated the safety of laparoscopic repair for perforated peptic ulcer, no definite guidelines have been published on selection of patients for laparoscopic repair. This cohort study aimed to define patients who may not benefit from laparoscopic techniques.


METHODS
The data from 374 consecutive patients with perforated peptic ulcer treated by simple repair were collected prospectively and analysed.


RESULTS
From January 1992 to December 1998, 219 patients were treated by open suture repair, 109 by laparoscopic sutureless (fibrin glue) repair and 46 by laparoscopic suture repair. The overall leak rate after laparoscopic suture and sutureless repair was 6 and 16 per cent respectively. Leakage was noted to be associated with a significantly higher rate of wound infection, intra-abdominal abscess formation, prolonged ileus (P < 0.001) and longer hospital stay (11 versus 5 days; P < 0.001). Multivariate analysis demonstrated that Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission predicted the likelihood of a leak after laparoscopic fibrin glue repair (P = 0.006).


CONCLUSIONS
APACHE II score may be a useful index for selecting patients for laparoscopic fibrin glue repair.
Lee
F Y
FY
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Leung
K L
KL
Lai
P B
PB
Lau
J W
JW
D018806:APACHE; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D018579:Patient Selection; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D015996:Survival Rate
D000700:Analgesics; D015718:Fibrin Tissue Adhesive