Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Gianluca Costa; Pietro Fransvea; Luca Lepre; Gianluca Liotta; Gianluca Mazzoni; Alan Biloslavo; Valentina Bianchi; Savino Occhionorelli; Alessandro Costa; Gabriele Sganga; Ferdinando Agresta; Giovanni Alemanno; Massimo Antropoli; Nicola Apice; Giulio Argenio; Nicola Avenia; Antonio Azzinnaro; Andrea Barberis; Giorgio Badessi; Gianadnrea Baldazzi; Carlo Bergamini; G. Bianco; Alan Biloslavo; Cristina Bombardini; Giuseppe Borzellino; Gioia Brachini; Buonanno Gennaro Maurizio; Tiberio Canini; Gabriella Teresa Capolupo; Filippo Carannante; Marco Caricato; Diletta Cassini; Maurizio Castriconi; Alberto Catamerò; Marco Catarci; Graziano Ceccarelli; Giovanni Maria Ceccarelli; Marco Ceresoli; Massimo Chiarugi; Nicola Cillara; Roberto Cirocchi; Luigi Cobuccio; Federico Coccolini; Gianfranco Cocorullo; Valerio Cozza; Antonio Crucitti; Eugenio Cucinotta; Rosella D’Alessio; Andrea De Manzoni Garberini; Nicolò De Manzini; Carlo De Nisco; Marco De Prizio; Elena Finotti; Pietro Fransvea; Barbara Frezza; Giovanni Maria Garbarino; Gianluca Garulli; Michele Genna; Stefano Giannessi; Alessio Giordano; Mario Guerrieri; Veronica Iacopini; Hayato Kurihara; Antonio La Greca; Giovanni Guglielmo Laracca; Ernesto Laterza; Luca Lepre; Gianluca Liotta; Diego Mariani; Pierluigi Marini; Rinaldo Marzaioli; Gianluca Mascianà; Gianluca Mazzoni; Paolo Mercantini; Valentina Miacci; Andrea Mingoli; Giuseppe Miranda; Savini Occhionorelli; Nadiane Paderno; Gian M. Palini; Daniele Paradies; Luca Petruzzelli; Angela Pezzolla; Diego Piazza; Vincenzo Piazza; Giusto Pignata; E. Pinotti; Adolfo Pisanu; Caterina Puccioni; Aldo Rocca; Fabio Rondelli; Paolo Ruscelli; Sapienza Paolo; Marco Scattizzi; Angelo Erao; Gabriele Sganga; Dario Tartaglia; Giovanni Tebala; Cristian Tranà; Mauro Zago

doi:10.1007/s00464-023-09998-5

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Gianluca Costa, Pietro Fransvea, Luca Lepre, Gianluca Liotta, Gianluca Mazzoni, Alan Biloslavo, Valentina Bianchi, Savino Occhionorelli, Alessandro Costa, Gabriele Sganga, Ferdinando Agresta, Giovanni Alemanno, Massimo Antropoli, Nicola Apice, Giulio Argenio, Nicola Avenia, Antonio Azzinnaro, Andrea Barberis, Giorgio Badessi, Gianadnrea BaldazziCarlo Bergamini, G. Bianco, Alan Biloslavo, Cristina Bombardini, Giuseppe Borzellino, Gioia Brachini, Buonanno Gennaro Maurizio, Tiberio Canini, Gabriella Teresa Capolupo, Filippo Carannante, Marco Caricato, Diletta Cassini, Maurizio Castriconi, Alberto Catamerò, Marco Catarci, Graziano Ceccarelli, Giovanni Maria Ceccarelli, Marco Ceresoli, Massimo Chiarugi, Nicola Cillara, Roberto Cirocchi, Luigi Cobuccio, Federico Coccolini, Gianfranco Cocorullo, Valerio Cozza, Antonio Crucitti, Eugenio Cucinotta, Rosella D’Alessio, Andrea De Manzoni Garberini, Nicolò De Manzini, Carlo De Nisco, Marco De Prizio, Elena Finotti, Pietro Fransvea, Barbara Frezza, Giovanni Maria Garbarino, Gianluca Garulli, Michele Genna, Stefano Giannessi, Alessio Giordano, Mario Guerrieri, Veronica Iacopini, Hayato Kurihara, Antonio La Greca, Giovanni Guglielmo Laracca, Ernesto Laterza, Luca Lepre, Gianluca Liotta, Diego Mariani, Pierluigi Marini, Rinaldo Marzaioli, Gianluca Mascianà, Gianluca Mazzoni, Paolo Mercantini, Valentina Miacci, Andrea Mingoli, Giuseppe Miranda, Savini Occhionorelli, Nadiane Paderno, Gian M. Palini, Daniele Paradies, Luca Petruzzelli, Angela Pezzolla, Diego Piazza, Vincenzo Piazza, Giusto Pignata, E. Pinotti, Adolfo Pisanu, Caterina Puccioni, Aldo Rocca, Fabio Rondelli, Paolo Ruscelli, Sapienza Paolo, Marco Scattizzi, Angelo Erao, Gabriele Sganga, Dario Tartaglia, Giovanni Tebala, Cristian Tranà, Mauro Zago

Risultato della ricerca: Contributo in rivista › Articolo in rivista

Abstract

Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.

Lingua originale	English
pagine (da-a)	5137-5149
Numero di pagine	13
Rivista	Surgical Endoscopy
Volume	37
DOI	https://doi.org/10.1007/s00464-023-09998-5
Stato di pubblicazione	Pubblicato - 2023

Keywords

Laparoscopic approach
Perforated peptic ulcer
Surgical treatment

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10.1007/s00464-023-09998-5

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Costa, G., Fransvea, P., Lepre, L., Liotta, G., Mazzoni, G., Biloslavo, A., Bianchi, V., Occhionorelli, S., Costa, A., Sganga, G., Agresta, F., Alemanno, G., Antropoli, M., Apice, N., Argenio, G., Avenia, N., Azzinnaro, A., Barberis, A., Badessi, G., ... Zago, M. (2023). Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach. Surgical Endoscopy, 37, 5137-5149. https://doi.org/10.1007/s00464-023-09998-5

@article{dc59a88f794248e3805e8885a15562d0,

title = "Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach",

abstract = "Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.",

keywords = "Laparoscopic approach, Perforated peptic ulcer, Surgical treatment, Laparoscopic approach, Perforated peptic ulcer, Surgical treatment",

author = "Gianluca Costa and Pietro Fransvea and Luca Lepre and Gianluca Liotta and Gianluca Mazzoni and Alan Biloslavo and Valentina Bianchi and Savino Occhionorelli and Alessandro Costa and Gabriele Sganga and Ferdinando Agresta and Giovanni Alemanno and Massimo Antropoli and Nicola Apice and Giulio Argenio and Nicola Avenia and Antonio Azzinnaro and Andrea Barberis and Giorgio Badessi and Gianadnrea Baldazzi and Carlo Bergamini and G. Bianco and Alan Biloslavo and Cristina Bombardini and Giuseppe Borzellino and Gioia Brachini and Maurizio, {Buonanno Gennaro} and Tiberio Canini and Capolupo, {Gabriella Teresa} and Filippo Carannante and Marco Caricato and Diletta Cassini and Maurizio Castriconi and Alberto Catamer{\`o} and Marco Catarci and Graziano Ceccarelli and Ceccarelli, {Giovanni Maria} and Marco Ceresoli and Massimo Chiarugi and Nicola Cillara and Roberto Cirocchi and Luigi Cobuccio and Federico Coccolini and Gianfranco Cocorullo and Valerio Cozza and Antonio Crucitti and Eugenio Cucinotta and Rosella D{\textquoteright}Alessio and {De Manzoni Garberini}, Andrea and {De Manzini}, Nicol{\`o} and {De Nisco}, Carlo and {De Prizio}, Marco and Elena Finotti and Pietro Fransvea and Barbara Frezza and Garbarino, {Giovanni Maria} and Gianluca Garulli and Michele Genna and Stefano Giannessi and Alessio Giordano and Mario Guerrieri and Veronica Iacopini and Hayato Kurihara and {La Greca}, Antonio and Laracca, {Giovanni Guglielmo} and Ernesto Laterza and Luca Lepre and Gianluca Liotta and Diego Mariani and Pierluigi Marini and Rinaldo Marzaioli and Gianluca Mascian{\`a} and Gianluca Mazzoni and Paolo Mercantini and Valentina Miacci and Andrea Mingoli and Giuseppe Miranda and Savini Occhionorelli and Nadiane Paderno and Palini, {Gian M.} and Daniele Paradies and Luca Petruzzelli and Angela Pezzolla and Diego Piazza and Vincenzo Piazza and Giusto Pignata and E. Pinotti and Adolfo Pisanu and Caterina Puccioni and Aldo Rocca and Fabio Rondelli and Paolo Ruscelli and Sapienza Paolo and Marco Scattizzi and Angelo Erao and Gabriele Sganga and Dario Tartaglia and Giovanni Tebala and Cristian Tran{\`a} and Mauro Zago",

year = "2023",

doi = "10.1007/s00464-023-09998-5",

language = "English",

volume = "37",

pages = "5137--5149",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer",

}

Costa, G, Fransvea, P, Lepre, L, Liotta, G, Mazzoni, G, Biloslavo, A, Bianchi, V, Occhionorelli, S, Costa, A, Sganga, G, Agresta, F, Alemanno, G, Antropoli, M, Apice, N, Argenio, G, Avenia, N, Azzinnaro, A, Barberis, A, Badessi, G, Baldazzi, G, Bergamini, C, Bianco, G, Biloslavo, A, Bombardini, C, Borzellino, G, Brachini, G, Maurizio, BG, Canini, T, Capolupo, GT, Carannante, F, Caricato, M, Cassini, D, Castriconi, M, Catamerò, A, Catarci, M, Ceccarelli, G, Ceccarelli, GM, Ceresoli, M, Chiarugi, M, Cillara, N, Cirocchi, R, Cobuccio, L, Coccolini, F, Cocorullo, G, Cozza, V, Crucitti, A, Cucinotta, E, D’Alessio, R, De Manzoni Garberini, A, De Manzini, N, De Nisco, C, De Prizio, M, Finotti, E, Fransvea, P, Frezza, B, Garbarino, GM, Garulli, G, Genna, M, Giannessi, S, Giordano, A, Guerrieri, M, Iacopini, V, Kurihara, H, La Greca, A, Laracca, GG, Laterza, E, Lepre, L, Liotta, G, Mariani, D, Marini, P, Marzaioli, R, Mascianà, G, Mazzoni, G, Mercantini, P, Miacci, V, Mingoli, A, Miranda, G, Occhionorelli, S, Paderno, N, Palini, GM, Paradies, D, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Puccioni, C, Rocca, A, Rondelli, F, Ruscelli, P, Paolo, S, Scattizzi, M, Erao, A, Sganga, G, Tartaglia, D, Tebala, G, Tranà, C & Zago, M 2023, 'Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach', Surgical Endoscopy, vol. 37, pagg. 5137-5149. https://doi.org/10.1007/s00464-023-09998-5

TY - JOUR

T1 - Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

AU - Costa, Gianluca

AU - Fransvea, Pietro

AU - Lepre, Luca

AU - Liotta, Gianluca

AU - Mazzoni, Gianluca

AU - Biloslavo, Alan

AU - Bianchi, Valentina

AU - Occhionorelli, Savino

AU - Costa, Alessandro

AU - Sganga, Gabriele

AU - Agresta, Ferdinando

AU - Alemanno, Giovanni

AU - Antropoli, Massimo

AU - Apice, Nicola

AU - Argenio, Giulio

AU - Avenia, Nicola

AU - Azzinnaro, Antonio

AU - Barberis, Andrea

AU - Badessi, Giorgio

AU - Baldazzi, Gianadnrea

AU - Bergamini, Carlo

AU - Bianco, G.

AU - Biloslavo, Alan

AU - Bombardini, Cristina

AU - Borzellino, Giuseppe

AU - Brachini, Gioia

AU - Maurizio, Buonanno Gennaro

AU - Canini, Tiberio

AU - Capolupo, Gabriella Teresa

AU - Carannante, Filippo

AU - Caricato, Marco

AU - Cassini, Diletta

AU - Castriconi, Maurizio

AU - Catamerò, Alberto

AU - Catarci, Marco

AU - Ceccarelli, Graziano

AU - Ceccarelli, Giovanni Maria

AU - Ceresoli, Marco

AU - Chiarugi, Massimo

AU - Cillara, Nicola

AU - Cirocchi, Roberto

AU - Cobuccio, Luigi

AU - Coccolini, Federico

AU - Cocorullo, Gianfranco

AU - Cozza, Valerio

AU - Crucitti, Antonio

AU - Cucinotta, Eugenio

AU - D’Alessio, Rosella

AU - De Manzoni Garberini, Andrea

AU - De Manzini, Nicolò

AU - De Nisco, Carlo

AU - De Prizio, Marco

AU - Finotti, Elena

AU - Fransvea, Pietro

AU - Frezza, Barbara

AU - Garbarino, Giovanni Maria

AU - Garulli, Gianluca

AU - Genna, Michele

AU - Giannessi, Stefano

AU - Giordano, Alessio

AU - Guerrieri, Mario

AU - Iacopini, Veronica

AU - Kurihara, Hayato

AU - La Greca, Antonio

AU - Laracca, Giovanni Guglielmo

AU - Laterza, Ernesto

AU - Lepre, Luca

AU - Liotta, Gianluca

AU - Mariani, Diego

AU - Marini, Pierluigi

AU - Marzaioli, Rinaldo

AU - Mascianà, Gianluca

AU - Mazzoni, Gianluca

AU - Mercantini, Paolo

AU - Miacci, Valentina

AU - Mingoli, Andrea

AU - Miranda, Giuseppe

AU - Occhionorelli, Savini

AU - Paderno, Nadiane

AU - Palini, Gian M.

AU - Paradies, Daniele

AU - Petruzzelli, Luca

AU - Pezzolla, Angela

AU - Piazza, Diego

AU - Piazza, Vincenzo

AU - Pignata, Giusto

AU - Pinotti, E.

AU - Pisanu, Adolfo

AU - Puccioni, Caterina

AU - Rocca, Aldo

AU - Rondelli, Fabio

AU - Ruscelli, Paolo

AU - Paolo, Sapienza

AU - Scattizzi, Marco

AU - Erao, Angelo

AU - Sganga, Gabriele

AU - Tartaglia, Dario

AU - Tebala, Giovanni

AU - Tranà, Cristian

AU - Zago, Mauro

PY - 2023

Y1 - 2023

N2 - Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.

AB - Background: Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. Methods: A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. Results: A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien–Dindo classification, the severity of postoperative complications was statistically different only for C–D 1–2. Conclusions: Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.

KW - Laparoscopic approach

KW - Perforated peptic ulcer

KW - Surgical treatment

KW - Laparoscopic approach

KW - Perforated peptic ulcer

KW - Surgical treatment

UR - http://hdl.handle.net/10807/303653

U2 - 10.1007/s00464-023-09998-5

DO - 10.1007/s00464-023-09998-5

M3 - Article

SN - 0930-2794

VL - 37

SP - 5137

EP - 5149

JO - Surgical Endoscopy

JF - Surgical Endoscopy

ER -

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Abstract

Keywords

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