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OUTCOMES OF EMERGENCY LAPAROSCOPIC VS. OPEN SURGERY FOR COMPLICATED ACUTE PEPTIC ULCER DISEASE
S Shebrain, C Dillon, G Munene, R Sawyer
Western Michigan University

Background
Acute perforation and bleeding are serious complications associated with peptic ulcer disease (PUD). Laparotomy remains the traditional operative intervention for repair. However, the laparoscopic approach has gained popularity over the last two decades as minimally invasive surgery evolves. This study aims to evaluate the 30-days outcomes of laparoscopic and open approach in patients presented with acute PUD, bleeding and perforation.

Methods
Using the ACS-NSQIP database (2017), patients who presented with acute complication of PUD were identified and divided into two groups: laparoscopic group (LG) and open group (OG). The outcomes examined included 30-day mortality, morbidity, overall, readmission rates, re-operation, operative time, and total length of hospital stay (LOS). Pearson’s chi-squared and Fisher’s exact tests were used to test group differences of categorical variables. Continuous variables were tested with the Student t-test, with statistical significance set at a value of p<0.05.

Results
Study group comprised of 1206 patients, 138 patients (11.4%) presented with bleeding, and 1068 patients (88.6%) with perforation. Laparoscopic group (LG), included 124 patients (10.3%) and open group (OG), included 1082 (89.7%). Overall, both groups had similar demographic characteristics. There were no differences in 30-day mortality between LG , and OG (4.9 % vs.7.1% , p=0.364). LG was associated with lower overall morbidity (49.9% vs. 54%, p=0.011), and lower serious morbidity (39.5% vs. 51%, p 48 hours was slightly higher in the OG (12.7% vs. 6.5%, p=0.044). LG had decreased mean (SD) hospital LOS, 8.8 (±7.5) vs. 10.7 (±9.7) days, p=0.038, but increased mean (SD) total operative time, 87(±35) vs. 75 (±35) minutes, p=0.001. There were no differences between LG and OG in reoperation (5.6% vs. 6.8%, p= 0.615), and 30-day readmission rate (8.1% vs. 9.0%, p=0.73).

Conclusion
No differences in 30-day mortality were noted between LG or OG. However, those who underwent an open approach tended to be have higher serious morbidity, overall morbidity, increased LOS. The laparoscopic approach should be attempted in all patients with acute complications of PUD unless patient instability requires the most expeditious procedure.


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