Dillon Conor H, Richter David M, Madani Rami, Saroya Ghazi, Elian Alain, Shebrain Saad
Department of Surgical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA.
Surg Endosc. 2025 May 27. doi: 10.1007/s00464-025-11855-6.
Acute perforation is a serious complication associated with peptic ulcer disease (PUD). Laparotomy remains the traditional operative intervention for repair. However, the laparoscopic approach has gained popularity over the last two decades. This study aims to evaluate the 30-day outcomes of laparoscopic and open approach in patients with acute PUD perforation.
Patients who presented emergently with acute gastroduodenal ulcer perforation between 2005 and 2017 were identified from the ACS-NSQIP database. Patients were stratified based on whether they underwent laparoscopic repair (LR) or open repair (OR) and selected using one-to-one propensity score matching (PSM). Primary outcomes included 30-day mortality, morbidity, readmission and reoperation rates, operative time, and total length of hospital stay (LOS). Categorical variables were assessed using Pearson's chi-squared or Fischer's exact tests. Continuous variables were tested with parametric or non-parametric tests.
7099 patients were identified; 775 (11%) underwent LR and 6324 (89%) underwent OR. 1534 patients were matched (767 patients per group); matched groups had similar demographic, comorbidity, and perioperative characteristics. There were no differences between LR and OR regarding 30-day mortality (5.6% vs. 6.9%, p = 0.292), overall morbidity (38.9% vs. 43.3%, p = 0.078), serious morbidity (36.1% vs. 37.3%, p = 0.634), and reoperation rate (5.5% vs. 6.5%, p = 0.454). LR had a lower 30-day readmission rate (6.5% vs. 7.3%, p = 0.002), lower overall minor morbidities (14.3% vs. 19.9%, p = 0.004), shorter median (IQR) LOS (6 [5,10] vs. 7 [5,11], p < 0.001). Median (IQR) operative time was longer in the LR group (83 [61, 109) vs. 63 [47, 86] minutes, p < 0.001).
LR of gastroduodenal ulcers is currently underutilized. Patients who underwent LR tended to have longer operative time, but shorter LOS, and lower readmission rates. There were no differences in 30-day mortality between LR and OR groups. Therefore, a laparoscopic approach should be attempted for patients presenting with acute perforation of gastroduodenal ulcers.
急性穿孔是消化性溃疡疾病（PUD）的一种严重并发症。剖腹手术仍然是传统的修复手术干预方式。然而，在过去二十年中，腹腔镜手术方法越来越受欢迎。本研究旨在评估急性PUD穿孔患者腹腔镜手术和开放手术的30天结局。
从ACS-NSQIP数据库中识别出2005年至2017年间因急性胃十二指肠溃疡穿孔而紧急就诊的患者。根据患者是否接受腹腔镜修复（LR）或开放修复（OR）进行分层，并使用一对一倾向评分匹配（PSM）进行选择。主要结局包括30天死亡率、发病率、再入院率和再次手术率、手术时间以及住院总时长（LOS）。分类变量使用Pearson卡方检验或Fischer精确检验进行评估。连续变量使用参数检验或非参数检验进行测试。
共识别出7099例患者；775例（11%）接受了LR，6324例（89%）接受了OR。1534例患者进行了匹配（每组767例患者）；匹配组在人口统计学、合并症和围手术期特征方面相似。LR组和OR组在30天死亡率（5.6%对6.9%，p = 0.292）、总体发病率（38.9%对43.3%，p = 0.078）、严重发病率（36.1%对37.3%，p = 0.634）和再次手术率（5.5%对6.5%，p = 0.454）方面没有差异。LR组的30天再入院率较低（6.5%对7.3%，p = 0.002），总体轻微发病率较低（14.3%对19.9%，p = 0.004），中位（IQR）LOS较短（6 [5,10]对7 [5,11]，p < 0.001）。LR组的中位（IQR）手术时间较长（83 [61, 109]对63 [47, 86]分钟，p < 0.001）。
目前胃十二指肠溃疡的LR应用不足。接受LR的患者手术时间往往较长，但LOS较短，再入院率较低。LR组和OR组在30天死亡率方面没有差异。因此，对于出现胃十二指肠溃疡急性穿孔的患者应尝试采用腹腔镜手术方法。
