Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | sâmbătă, 16 februarie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
English
British Flag| Romana Romanian Flag
 
Creditare EMC
Colegiul Medicilor
Va invitam sa va inregistrati/abonati la Jurnalul de chirurgie pentru a beneficia de creditare EMC
User

Parola

Tine minte
Ti-ai uitat parola?
Syndicate

Advertisement

Elmed

Estima

Liamed

Listare E-mail

LAPAROSCOPIC REPAIR OF PEPTIC ULCER : BENEFITS AND LIMITS
A.E.Nicolau
Surgery Clinic, Emergency University Hospital, Bucharest
Jurnalul de chirurgie 2010; 6 (4): 409-419
Full text:
Format PDF (Română/Romanian)

Abstract:

The aim of our study is to evaluate the advantages and limits of the laparoscopic approach of  perforated peptic ulcer (PPU) in concurrence with the latest published data. The suture of  PPU associated to peritoneal lavage  and complete antiulcer therapy (antisecretory therapy and therapy for H.pylori eradication) is the standard procedure.The benefits of laparoscopic approach, in comparison with the open approach, are: lower postoperative analgetics use, shorter hospital stay, earlier return to normal activities, lower rate of wound complication, lower morbidity and mortality rate, but longer operative time and a higher incidence of suture-side leakage and postoperative intraoperitoneal abscesses. The major risk factors which determine an increase of the postoperative mortality and morbidity unrelated to the operative approach are represented by the Boey risk factors (shock at admission, delayed presentation,>24h, associated severe comorbidities), older age, perforations larger than 1cm, poor laparoscopic expertise of the surgical team. The Boey score, specific to the PPU, predicts the postoperative mortality and morbidity and is useful to select patients for laparoscopic repair. Septic shock represents an absolute contraindication for laparoscopy. The hemodynamic instability, contraindication of pneumoperitoneum, multi-operated abdomen, coexistence of ulcer hemorrhage, the absence of optimal technical equipment require the open approach. The best postoperative results after the laparoscopic approach are observed in low-risk patients and laparoscopic repair of PPU should be the procedure of choice in these cases. It is necessary for to undergo randomized multicentric trials which would evaluate the advantages of the laparoscopic approach of the PPU from an operative technique point of view, postoperative leaks, re-operations and postoperative mortality in high-risks patients.

KEY WORDS: PERFORATED PEPTIC ULCER, LAPAROSCOPIC REPAIR, RISKS FACTORS

Correspondence to: A.E. Nicolau, MD, PhD, Surgery Clinic, Emergency University Hospital, Bucharest, e-mail:



: Creative Commons License
Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.