title: Risk factors associated with conversion of laparoscopic simple closure in perforated duodenal ulcer.
abstract: BACKGROUND
  Precise patient selection criteria are necessary to guide the surgeon in selecting laparoscopic repair for patients with perforated peptic ulcers. The aims of this study are to report surgical outcomes after surgery for perforated duodenal ulcers and identify risk factors for predicting failure of laparoscopic simple closure for perforated duodenal ulcer.
  
  
  METHODS
  In total, 77 patients who underwent laparoscopic simple closure for perforated duodenal ulcers from January 2007 to September 2013 were retrospectively analyzed. Patients were divided into totally laparoscopic and conversion groups. The characteristics of patients, intraoperative findings, postoperative complications, conversion rates and suture leakage rates of each group were investigated.
  
  
  RESULTS
  Laparoscopic repair was completed in 69 (89.6%) of 77 patients, while 8 (10.4%) underwent conversion to open repair. Patients in the conversion group had longer perforation time, larger perforation size, more suture leakage, longer hospital stay, and higher 30-day mortality rate than those in the totally laparoscopic group. The size of perforation was the only risk factor for conversion in multivariable analysis. Patients with an ulcer perforation size of ≥9 mm or with perforation duration of ≥12.5 h had a significantly increased risk for conversion and suture leakage.
  
  
  CONCLUSIONS
  Ulcer size of ≥9 mm is a significant risk factor for predicting conversion in laparoscopic simple closure. Suture leakage is associated with ulcer size (9 mm) and duration of perforation (12.5 h).
authors: Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors: Ji-Hyun
authors: JH
authors: Kim
authors: Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors: Hyung-Min
authors: HM
authors: Chin
authors: Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors: You-Jin
authors: YJ
authors: Bae
authors: Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. Electronic address: dkkwkh@catholic.ac.kr.
authors: Kyong-Hwa
authors: KH
authors: Jun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery / Q000009:adverse effects*; D004381:Duodenal Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects; D017211:Treatment Failure; D055815:Young Adult
keywords: Conversion; Laparoscopic simple closure; Perforated duodenal ulcer; Totally laparoscopic