Department of Surgery, Keelung Branch, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, 204201, Keelung City, Taiwan.
Division of Transplantation, Department of Surgery, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
BMC Surg. 2023 Sep 27;23(1):295. doi: 10.1186/s12893-023-02192-3.
Peptic ulcers are caused by unbalanced acid production, and proton pump inhibitors (PPIs) in recent decades have helped to treat peptic ulcers effectively. Meanwhile, the incidence of perforated peptic ulcer (PPU) persists and has a high mortality rate if there is no adequate management. Primary closure with a modified Graham's patch was well performed in early detected PPU with a small size < 2 cm. A laparoscopic approach for PPU was prescribed for decades with proven feasibility and safety. We introduced an effective technique combined with barbed suture and modified Graham's patch, which can significantly reduce the surgical time without significantly increasing morbidity and mortality compared with traditional interrupted suture.
We retrospectively collected data from January 2014 to December 2020 in Keelung Change Gung Memorial Hospital, and a total of 154 patients receiving laparoscopic repair of PPU were included. There were 59 patients in the V-loc group (V group) and 95 patients in the laparoscopic primary repair group (P group).
The V group had a significantly shorter operation time than the P group (96.93 ± 22.14 min vs. 123.97 ± 42.14, P < 0.001). Ten patients suffered from morbidity greater than the Clavien‒Dindo classification 4 (5 from V group, and 5 from P group). Three patients with leakage were reported. Two patients were in the V group, and one patient was in the P group (p = 0.432).
Laparoscopic repair with barbed suture and modified Graham's patch provides a simple and effective technique in the management of acute abdomen. This technique can be easily performed by experienced surgeons and trainees in minimally invasive surgery without affecting patient safety.
消化性溃疡是由胃酸分泌失衡引起的，质子泵抑制剂（PPIs）在近几十年来已被证明可有效治疗消化性溃疡。然而，穿孔性消化性溃疡（PPU）的发病率仍然存在，如果管理不当，其死亡率很高。对于早期发现且直径小于 2cm 的小尺寸 PPU，采用改良 Graham 补丁的一期缝合可取得良好的效果。几十年来，腹腔镜方法已被用于治疗 PPU，并已被证明具有可行性和安全性。我们引入了一种有效的技术，结合使用带倒刺的缝线和改良 Graham 补丁，可以显著缩短手术时间，且与传统间断缝合相比，并不会显著增加发病率和死亡率。
我们回顾性地收集了自 2014 年 1 月至 2020 年 12 月在基隆长庚纪念医院接受腹腔镜 PPU 修补术的 154 例患者的数据。V-loc 组（V 组）有 59 例患者，腹腔镜一期修补组（P 组）有 95 例患者。
V 组的手术时间明显短于 P 组（96.93±22.14min 比 123.97±42.14min，P<0.001）。V 组有 10 例患者的发病率大于 Clavien-Dindo 分类 4（5 例来自 V 组，5 例来自 P 组）。报告了 3 例漏诊。2 例发生在 V 组，1 例发生在 P 组（p=0.432）。
腹腔镜下带倒刺缝线和改良 Graham 补丁修复术为急性腹痛的治疗提供了一种简单有效的方法。这种技术可以由经验丰富的外科医生和微创外科的学员轻松实施，而不会影响患者的安全。
