This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Selection of patients for laparoscopic repair of perforated peptic ulcer. BJS 2001; 88: 133-136.

Published: 6th December 2002

Authors: F. Y. J. Lee, K. L. Leung, P. B. S. Lai, J. W. Y. Lau

Background

Although randomized and non‐randomized studies have evaluated the safety of laparoscopic repair for perforated peptic ulcer, no definite guidelines have been published on selection of patients for laparoscopic repair. This cohort study aimed to define patients who may not benefit from laparoscopic techniques.

Method

The data from 374 consecutive patients with perforated peptic ulcer treated by simple repair were collected prospectively and analysed.

Results

From January 1992 to December 1998, 219 patients were treated by open suture repair, 109 by laparoscopic sutureless (fibrin glue) repair and 46 by laparoscopic suture repair. The overall leak rate after laparoscopic suture and sutureless repair was 6 and 16 per cent respectively. Leakage was noted to be associated with a significantly higher rate of wound infection, intra‐abdominal abscess formation, prolonged ileus (P < 0·001) and longer hospital stay (11 versus 5 days; P < 0·001). Multivariate analysis demonstrated that Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission predicted the likelihood of a leak after laparoscopic fibrin glue repair (P = 0·006).

Conclusion

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