title: The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer.
abstract: BACKGROUND
  The use of laparoscopic repair for perforated peptic ulcer (PPU) was shown to be safe and recommended in low-risk patients. However, whether the approach is safe to apply to high-risk patients is uncertain.
  
  
  METHODS
  This was a retrospective study of all patients with PPU admitted between January 2002 and December 2012. The laparoscopy-first approach (LFA) was adopted as a routine for all patients. The outcomes of LFA for PPU were reviewed and assessed to determine if the approach was safe in high-risk patients.
  
  
  RESULTS
  Three hundred and seventy three patients that suffered from PPU were included into the study and 50.9% received laparoscopic repair. There was a significant increase in the number of operations performed yearly by the LFA (P < 0.001). 25.2% of the patients had a Boey score of ≥2. High-risk patients that received LFA suffered from larger ulcers (P < 0.001) with more severe contamination (P = 0.006) that required conversion (P = 0.002) when compared to the low-risk patients. When compared to open surgery, more high-risk patients in the open group had ASA grade ≥3 (P = 0.007) and suffered from mortality (P = 0.001). The only significant predictor to mortality in high-risk patients was ASA grade ≥3 (P = 0.014).
  
  
  CONCLUSIONS
  The adoption of LFA in patients suffering from PPU was associated with acceptable rates of mortality and morbidity. The approach could also be selectively adopted in patients with Boey score ≥2 provided their ASA grading is low and hemodynamically stable.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, New Territories, Hong Kong, anthonyteoh@surgery.cuhk.edu.hk.
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
authors.forename: Amy Siu Yan
authors.initials: AS
authors.lastname: Kok
authors.forename: Simon Kin Hung
authors.initials: SK
authors.lastname: Wong
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index