Laparoscopic Surgery for Perforated XXXX : Analysis of 70 Consecutive Cases From a Single Surgeon.

@entity1 @entity204 @entity4773 @entity260
BACKGROUND: In the surgical treatment of @entity4773 , laparoscopic surgery has become a key technique. However, difficult cases are not eligible for laparoscopic surgery. The purpose of this study was to evaluate the risk factors for @entity260 and to examine the safety and effectiveness of laparoscopic surgery. MATERIALS AND METHODS: Seventy duodenal ulcer perforation @entity1 who underwent laparoscopic surgery between July 2010 and March 2014 were reviewed. The type of surgery was chosen on the basis of the size of the perforation. All @entity1 were classified into 2 groups according to the surgical treatment method: primary repair with omentopexy (PR group, n=56) and distal gastrectomy with truncal vagotomy (DG group, n=14). RESULTS: No conversions to open surgery occurred. Three @entity204 (mortality rate, 4.1%) occurred within 90 postoperative days. @entity260 , including 5 severe complications, occurred in 9 @entity1 . There were no differences between the PR and DG groups, except in the mean operation time. In univariate analysis, history of nonsteroidal anti-inflammatory drug use, American Society of Anesthesiologist score (over 3), presence of shock, and time to surgery from symptom onset until surgery (over 48 h) were prognostic factors for @entity260 . Of particular note, the different perforation sizes were not significantly different. Multivariate analysis showed that history of nonsteroidal anti-inflammatory drug use and treatment delay (48 h) were independent risk factors for @entity260 . The presence of shock on admission was a risk factor for severe @entity260 . CONCLUSIONS: Our results suggest that laparoscopic surgery may be applied to all duodenal ulcer perforations. However, because of the learning period, we believe that laparoscopic surgery may not be suited to every surgeon. However, when performed by laparoscopic experts, laparoscopic surgery can be a valuable approach for treating @entity4773 .
