title: Laparoscopic versus Open Omental Patch Repair for Early Presentation of Perforated Peptic Ulcer: Matched Retrospective Cohort Study.
abstract: Introduction.The aim of this study was to compare the outcomes between laparoscopic and open omental patch repair (LOPR versus OR) in patients with similar presentation of perforated peptic ulcer (PPU). The secondary aim was to evaluate the outcomes according to the severity of peritonitis.Methods.All patients who underwent omental patch repair at two university-affiliated institutes between January 2010 and December 2014 were reviewed. Matched cohort between LOPR and OR groups was achieved by only including patients that had ulcer perforation <2 cm in size and symptoms occurring <48 hours. Outcome measures were defined in accordance with length of stay (LOS), postoperative complications, and mortality.Results.148 patients met the predefined inclusion criteria with LOPR performed in 40 patients. Outcome measures consistently support laparoscopic approach but only length of hospital stay (LOS) achieved statistical significance (LOPR 4 days versus OR 5 days,p< 0.01). In a subgroup analysis of patients with MPI score >21, LOPR is also shown to benefit, particularly resulting in significant shorter LOS (4 days versus 11 days,p< 0.01).Conclusion.LOPR offers improved short-term outcomes in patients who present within 48 hours and with perforation size <2 cm. LOPR also proved to be more beneficial in high MPI cases.
authors.affiliation: Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828.
authors.forename: Daniel Jin Keat
authors.identifier: 0000-0002-0741-5386
authors.initials: DJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828.
authors.forename: MaDong
authors.identifier: 0000-0001-8435-9413
authors.initials: M
authors.lastname: Ye
authors.affiliation: Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Keith Haozhe
authors.initials: KH
authors.lastname: Sun
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Vishalkumar G
authors.identifier: 0000-0003-3988-8142
authors.initials: VG
authors.lastname: Shelat
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Aaryan
authors.initials: A
authors.lastname: Koura