Materials and methods
Results
Study | EPHPP | Study design | Number patients | Procedure | Conversion rate (%) |
---|---|---|---|---|---|
Vaidya 2009 | Weak | NRP | 31 | Lap | 6.5 |
Ates 2008 | Moderate | NRP | 17 | Lap | 17.6 |
Song 2008 | Weak | NRP | 35 | Lap | 5.7 |
Bhogal 2008 | Moderate | NRP | 19 | Lap | 0.0 |
14 | Open | ||||
Ates 2007 | Weak | NRP | 17 | Lap | 17.6 |
18 | Open | ||||
Malkov 2004 | Moderate | NRP | 42 | Lap | 0.0 |
40 | Open | ||||
Siu 2004 | Moderate | NRP | 172 | Lap | 21.5 |
Arnaud 2002 | Weak | NRP | 30 | Lap | 16.6 |
Lee 2001 | Weak | NRP | 155 | Lap | 28.5 |
219 | Open | ||||
Khourseed 2000 | Weak | NRP | 21 | Lap | 4.7 |
Kathkouda 1999 | Weak | NRP | 30 | Lap | 17.0 |
16 | Open | ||||
Bergamaschi 1999 | Weak | NRP | 17 | Lap | 23.5 |
N | 62 | Open | |||
Matsuda 1995 | Weak | NRP | 11 | Lap | 21.4 |
55 | Open | ||||
Lee 2004 | Weak | NRP | 30 | Lap | 3.3 |
Druart | Moderate | NRP | 100 | Lap | 8.0 |
Siu 2002 | Strong | PR | 63 | Lap | 14.2 |
58 | Open | ||||
Lau 1996 | Moderate | PR | 52 | Lap | 23.0 |
51 | Open | ||||
Bertleff 2009 | Strong | PR | 52 | Lap | 7.7 |
49 | Open | ||||
Palanivelu 2007 | Weak | R | 120 | Lap | 0.0 |
Lunevicius 2005 | Moderate | R | 60 | Lap | 23.3 |
162 | Open | ||||
Lunevicius IV | Weak | R | 60 | Lap | 23.3 |
Kirshtein 2005 | Weak | R | 68 | Lap | 4.4 |
66 | Open | ||||
Tsumura 2004 | Weak | R | 58 | Lap | 12.0 |
13 | Open | ||||
Seelig 2003 | Weak | R | 24 | Lap | 12.5 |
31 | Open | ||||
Al Aali 2002 | Weak | R | 60 | Lap | 6.6 |
38 | Open | ||||
Lee 2001 I | Weak | R | 209 | Lap | 26.8 |
227 | Open | ||||
Robertson | Weak | R | 20 | Lap | 10.0 |
16 | Open | ||||
So 1996 | Weak | R | 15 | Lap | 6.6 |
38 | Open | ||||
Johansson 1996 | Weak | R | 10 | Lap | 0.0 |
17 | Open | ||||
Total
|
2788
|
12.4
|
Total (n = 2,784) | ||
---|---|---|
Age (years) | 48 | n = 2,328 |
Male (%) | 79 | n = 2,678 |
History of ulcer (%) | 29 | n = 1,140 |
History of NSAID use (%) | 20 | n = 1,109 |
Smokers (%) | 62 | n = 472 |
Alcohol use (%) | 29 | n = 198 |
ASA I (%) | 35 | n = 1,120 |
ASA II (%) | 37 | n = 1,060 |
ASA III (%) | 20 | n = 1,060 |
ASA IV (%) | 9 | n = 1,030 |
Boey 0 | 59 | n = 513 |
Boey 1 | 23 | n = 513 |
Boey 2 | 16 | n = 513 |
Boey 3 | 2 | n = 513 |
Shock at admission (%) | 7 | n = 1,107 |
Duration of symptoms (h) | 13.6 | n = 837 |
Free air on X-ray (%) | 85 | n = 510 |
Symptoms >24 h (%) | 11 | n = 723 |
Size perforation (mm) | 5.5 | n = 691 |
Manheim peritonitis index | 15.1 | n = 220 |
WBC | 12.3 | n = 147 |
Localization ulcer | ||
Duodenal (%) | 67 | n = 1,355 |
Juxtapyloric (%) | 23 | n = 1,355 |
Gastric (%) | 17 | n = 1,355 |
Laparoscopic correction | Siu 2002 | Lau 1996 | Bertleff 2009 | Average |
---|---|---|---|---|
Operating time (min) | 42 | 94 | 75 | 70.3 |
Nasogastric tube (days) | 3.0 | 2.5 | 2.0 | 2.5 |
Normal diet (days) | 4.0 | 4.0 | ||
Postoperative opiate use | 0 injections | 1.5 days | 1 day | |
Hospital stay (days) | 5.5 | 6.5 | 6.0 | |
Morbidity (%) | 25 | 23 | 18 | 22.0 |
Normal daily activities (days) | 10.4 | 10.4 | ||
Mortality (%) | 1.6 | 2 | 3.8 | 2.5 |
Ileus (days) | 0 | 0.0 | ||
Wound infection (%) | 0 | 0.0 | ||
Leakage (%) | 2.1 | 3.8 | 3.0 | |
VAS day 1 | 3.5 | 4.0 | 3.8 | 3.8 |
VAS day 3 | 1.6 | 2.1 | 1.9 |
Open correction PPU
| Siu 2002 | Lau 1996 | Bertleff 2009 | Average |
---|---|---|---|---|
Operating time (min) | 52.3 | 54 | 50 | 52.1 |
Nasogastric tube (days) | 3.0 | 2.5 | 3.0 | 2.8 |
Normal diet (days) | 4.0 | 4.0 | ||
Postoperative opiate use | 6 injections | 3.5 days | 1 day | |
Hospital stay (days) | 5 | 8 | 6.5 | |
Morbidity (%) | 50 | 22 | 36 | 36.0 |
Normal daily activities (days) | 26.1 | 26.1 | ||
Mortality (%) | 5.2 | 4.0 | 8.1 | 5.8 |
Ileus (days) | 2.0 | 2.0 | ||
Wound infection (%) | 6.1 | 6.1 | ||
Leakage (%) | 2.2 | 0 | 1.1 | |
VAS day 1 | 6.4 | 5.0 | 5.2 | 5.5 |
VAS day 3 | 3.3 | 3.0 | 3.2 |
Closure of perforation | 66% omental patch | 24% mixed techniques | 10% sutures only | |
Pneumoperitoneum | 26% Hassan trocar | 47% Veress needle | 26% mixed | |
Pneumoperitoneum | 75% 12 mmHg | 25% 11 or 14 mmHg | ||
Camera position | 35% supraumbilical | 35% umbilical | 30% infraumbilical | |
Number of trocars used | 60% four trocars | 40% three trocars | ||
Surgeon position | 44% between legs | 33% left side patient | 16% between or left side | 6% right side |
Irrigation fluid | 45% generous | 55% between 2 and 6 L | ||
Camera | 80% 30° | 10% 40° | 10% 0° | |
Nasogastric tubing | 94% yes | 6% no | ||
Abdominal drains | 79% yes | 21% no | ||
Suture material | 64% resorbable | 38% nonresorbable | ||
Knotting technique | 64% intracorporeal | 14% extracorporeal | 14% mix |
Scar problems | 9.9% |
Mortality | 5.8% |
Intra abdominal collection | 5.7% |
Wound infection | 4.9% |
MODS | 4.7% |
Sepsis | 4.6% |
Reoperation | 4.5% |
Prolonged ileus | 4.1% |
Suture leakage | 3.8% |
Pneumonia | 3.4% |
Respiratory complications | 3.3% |
Ulcer recurrence | 3.1% |
Intra-abdominal abscess | 2.7% |
Heart failure | 2.3% |
Hemorrhage | 2.0% |
Incisional hernia | 1.8% |
Atrial fibrillation | 1.7% |
Fistula | 1.7% |
Pneumothorax | 1.7% |
Urine retention | 1.7% |
Urinary tract infection | 1.6% |
Cerebral vascular accident | 1.0% |
Wound dehiscence | 0.8% |
Perforation size | 9.4% |
Inadequate ulcer localization | 6.6% |
Friable edges | 6.4% |
Adhesions | 5.9% |
Perforation gallbladder | 5.0% |
Cardiovascular instability | 4.4% |
Suspected tumor | 4.2% |
Severe peritonitis | 4.2% |
Posterior localization | 3.9% |
Definitive ulcer surgery | 3.2% |
Technical difficulties | 2.2% |
Pancreatic infiltration | 1.0% |
n = 1,874 | Laparoscopic (n = 843) | Open (n = 1,031) |
---|---|---|
Operating time (min) | 70.8 | 59.3 |
Nasogastric tube (days) | 23 | 3.0 |
Intravenous fluids (days) | 2.8 | 3.1 |
Abdominal drains (days) | 2.2 | 3.8 |
Urinary catheter (days) | 2.3 | 3.7 |
Normal diet (days) | 3.5 | 5.7 |
Prolonged ileus (days) | 2.7 | 3.6 |
Hospital stay (days) | 6.3 | 10.3 |
Wound infection (%) | 0.0 | 5.0 |
Suture leakage (%) | 6.3 | 2.6 |
Mobilization (days) | 1.9 | 3.3 |
Normal daily activity (days) | 12.7 | 16.6 |
Morbidity (%) | 14.3 | 26.9 |
Mortality (%) | 3.6 | 7.2 |
VAS day 1 | 3.8 | 6.4 |
VAS day 3 | 1.9 | 3.3 |
The procedure is safe | 16 |
Significantly less pain | 19 |
Significantly less mortality | 1 |
Significantly lower morbidity | 4 |
Significantly shorter operation time | 2 |
Significantly shorter hospital stay | 5 |
Significantly faster resumption of normal diet | 3 |
Significantly less wound infection | 2 |
No difference between laparoscopic repair or open | 2 |
Significantly longer operating time | 8 |
Significantly more suture leakage | 3 |
Significantly more reoperations | 1 |