title: Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study.
abstract: OBJECTIVE
  A perforated peptic ulcer can be managed laparoscopically in selected patients. The purpose of this study was to evaluate whether conversion of emergency laparoscopy is inferior to primary median laparotomy in terms of postoperative morbidity and mortality.
  
  
  METHODS
  We analyzed patients who underwent laparoscopic or open surgery for a perforated peptic ulcer at the Department of Surgery, University of Schleswig-Holstein, Campus Luebeck between January, 1996 and December, 2010. Perforations were graded according to the Boey classification, a preoperative risk-scoring system.
  
  
  RESULTS
  Conversion to laparotomy was necessary in 20 of the 45 patients who underwent laparoscopic surgery (CG); therefore, laparoscopic operations were completed in 25 patients (LG). The third patient cohort comprised 139 patients who underwent primary laparotomy (OG). Overall minor morbidity was significantly lower (p = 0.048) in the LG patients than in the OG patients, whereas no significant differences were found in major morbidity and mortality, particularly between the OG and CG.
  
  
  CONCLUSIONS
  Patients' suitability for laparoscopic management should be decided on according to Boey's clinical scoring system. Our findings demonstrated that conversion from laparoscopy to laparotomy was not associated with elevated postoperative morbidity or mortality versus initial laparotomy. Therefore, emergency operations may be commenced laparoscopically in selected patients, especially considering the postoperative advantages of this approach.
authors.affiliation: Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany. mark.zimmer@gmx.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany. drmartinhoffmann@yahoo.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany. tlaubert@googlemail.com.
authors.forename: Tilman
authors.initials: T
authors.lastname: Laubert
authors.affiliation: Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany. carlo.jung@gmx.de.
authors.forename: Carlo
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Surgery, Universitätsklinikum Schleswig-Holstein, Campus Lübeck Ratzeburger Allee 160, 23538, Lübeck, Germany. bruch@bdc.de.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.affiliation: Westküstenklinikum, Heide Esmarchstraße 50, 25746, Heide, Germany. e.schloericke@gmx.de.
authors.forename: Erik
authors.initials: E
authors.lastname: Schloericke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult
keywords: Conversion; Laparoscopic repair; Perforated peptic ulcer