title: Laparoscopic repair of perforated peptic ulcer: single-center results.
abstract: BACKGROUND
  Perforated peptic ulcer (PPU), the most common indication for emergency gastric surgery, is associated with high morbidity and mortality rates. Outcomes might be improved by performing this procedure laparoscopically, but no consensus exists on whether the benefits of laparoscopic repair (LR) of PPU outweigh the disadvantages.
  
  
  METHODS
  From January 2002 to December 2012, 111 patients underwent surgery for perforated ulcer. A "laparoscopy-first" policy was attempted and then applied for 56 patients. The exclusion criteria for LR ruled out patients who had shock at admission, severe cardiorespiratory comorbidities, or a history of supramesocolic surgery. The aim of this study was a retrospective analysis of the 56 patients treated laparoscopically.
  
  
  RESULTS
  The patient distribution was 30 men and 26 women, who had a mean age of 59 years (range 19-95 years). The mean ulcer size was 10 mm, and the Mannheim peritonitis index (MPI) was 21. LR was performed for 39 (69.6%) of the 56 patients and included peritoneal lavage, suturing of the perforation, and omental patching. Conversion to laparotomy was necessary in 17 cases (30.4%). The "conversion group" showed significant differences in ulcer size (larger ulcers: 1.9 vs. 0.7 mm; p < 0.01), ulcer-site topography (higher incidence of posterior ulcers: 5 vs. 0; p < 0.01), and MPI score (higher score: 24 vs. 20; p < 0.05). The LR group had a mean operating time of 86 min (range 50-125 min), an in-hospital morbidity rate of 7.6 %, a mortality rate of 2.5%, and a mean hospital stay of 6.7 days (range 5-12 days). None of these patients required reintervention.
  
  
  CONCLUSIONS
  The results showed that LR for PPU is feasible with acceptable mortality and morbidity rates. Skill in laparoscopic abdominal emergencies is required. Perforations 1.5 cm or larger, posterior duodenal ulcers, and an MPI higher than 25 should be considered the main risk factors for conversion.
authors.affiliation: Emergency Surgery Unit, Department of Emergency and Acceptance, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy, simone5c@virgilio.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Guadagni
authors.forename: Ismail
authors.initials: I
authors.lastname: Cengeli
authors.forename: Christian
authors.initials: C
authors.lastname: Galatioto
authors.forename: Niccolò
authors.initials: N
authors.lastname: Furbetta
authors.forename: Vincenzo Lippolis
authors.initials: VL
authors.lastname: Piero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zocco
authors.forename: Massimo
authors.initials: M
authors.lastname: Seccia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004381:Duodenal Ulcer / Q000473:pathology / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D061646:Operative Time; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D010533:Peritoneal Lavage; D011183:Postoperative Complications; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000473:pathology / Q000601:surgery; D055815:Young Adult