Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

• Published in: Surgical endoscopy Vol. 37; no. 1; pp. 715 - 722
• Main Authors: Odisho, Tanya, Shahait, Awni A., Sharza, Jared, Ali, Abubaker A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2023; Springer Nature B.V
• Subjects: 2022 SAGES Oral; Abdomen; Abdominal Surgery; Alcohol; Body mass index; Endoscopy; Female; Gastroenterology; Gynecology; Hepatology; Hospitals; Hospitals, Community; Humans; Laparoscopy; Laparoscopy - methods; Laparotomy; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nonsteroidal anti-inflammatory drugs; Observational studies; Patients; Peptic Ulcer Perforation - etiology; Peptic Ulcer Perforation - surgery; Postoperative Complications - etiology; Proctology; Retrospective Studies; Surgery; Sutures; Treatment Outcome; Ulcers; Open repair; Perforated peptic ulcer; Laparoscopic repair; Omental patch; Modified Cellan-Jones; Peritonitis
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09306-7

Introduction Minimally invasive or open Graham Patch repair remains the gold standard approach for management of perforated peptic ulcers (PPU). Herein, we report outcomes of laparoscopic technique and compare it with open approach at a community hospital. Methods Retrospective observational study conducted comparing laparoscopic modified Cellan-Jones repair (mCJR) versus the standard open repair of PPU. Patients aged 18–90 years during 2016–2021 were offered either a minimally invasive or open approach depending on surgeon laparoscopic capability, and were compared in terms of demographics, co-morbidities, intra-operative details, and short-term outcomes. Results A total of 49 patients were included (46.9% males, mean age 52.9 years, mean BMI 25.0, ASA ≥ III 75.5%, 75.5% smokers, 26.5% current NSAIDs use, and 71.4% alcohol drinkers). Duodenum was the most common perforation site (57.1%), and majority of ulcers were 1–2 cm (72.9%). Laparoscopic approach was performed in 16 consecutive patients (32.7%) by a single surgeon, with no conversions. Preoperative characteristics were similar for both groups. Compared to open approach, laparoscopic group were taken to operation immediately (< 4 h) (87.5% vs. 15.2%, p  < 0.001), had lower estimated blood loss (11.8 ml vs. 73.8 ml, p  = 0.063), and longer operative time (117.1 min vs. 85.6 min, p  = 0.010). Postoperatively, nasogastric tube was removed earlier in laparoscopic group (POD1-2, 87.5% vs. 24.2%, p  = 0.001), with earlier resumption of diet (POD1-2, 62.6% vs. 9.1%, p  = 0.002), less narcotic usage (< 3 days, 58.3% vs. 6.1%, p  < 0.001), earlier return of bowel function (POD1-2, 43.8% vs. 9.1%, p  = 0.003) and shorter length of stay (LOS) (3.7 days vs. 16.1 days, p  < 0.001). Both in-house mortality and morbidity rates were lower in the laparoscopic group, but not statistically significant [(0% vs. 6.1%, p  = 0.347) and (12.5% vs. 39.4%, p  = 0.500), respectively]. Conclusion Laparoscopic mCJR is a feasible method for repair of PPU, and it is associated with shorter LOS, and less narcotics usage in comparison to the open repair approach. Graphical abstract