Outcome After Laparoscopic Surgery for Peptic Ulcer Perforation

Study Overview
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Brief Summary
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Despite advances in laparoscopic surgery for perforated peptic ulcer (PPU), intra-abdominal abscess (IAA) is recognized as one of the commonly reported complications with relation to the extent of infectious abdominal contamination. Herein, the investigators report their experience of laparoscopic surgery for PPU with/without peritoneal irrigation and discuss postoperative outcome. The investigators retrospectively examined the electronic medical records of the patients who underwent laparoscopic surgery for perforated peptic ulcer at a single medical center in Taiwan between January 2013 and August 2021. Retrospectively, the investigators would include those patients with clinical diagnosis of PPU who underwent emergent laparoscopic surgery. The patients with previous abdominal surgery, pathologic confirmed malignant ulcer perforation or concomitant ulcer bleeding were excluded. The investigators focused on post-operative complications and outcome after laparoscopic surgery with or without peritoneal irrigation. This information can be important in improving surgical options with respect to risk and potential benefits in this setting.

Official Title
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Whether Peritoneal Irrigation Intra-operatively Effects on the Outcome After Laparoscopic Surgery for Peptic Ulcer Perforation

Conditions
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Intraabdominal Abscess After Procedure, Leakage, Pneumonia, Operation Wound; Infection

Intervention / Treatment
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* Procedure: Peritoneal irrigation
* Procedure: Suction only


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patients with clinical diagnosis of PPU underwent laparoscopic repair surgery. Exclusion Criteria: The patients received surgery in an open approach or underwent laparoscopy initially but then intraoperatively converted to laparotomy.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Irrigation group<br> | Procedure: Peritoneal irrigation<br>* For patients allocated to the irrigation group, peritoneal lavage was performed at the surgeon's discretion based on surgical findings and preference.<br>|
| Suction only group<br> | Procedure: Suction only<br>* In the suction only group, one surgical gauze each was placed in the splenophrenic space and Morison's pouch to soak up any remaining purulent fluid followed by turning the patient into the Trendelenburg position for inspection of the lower abdominal cavity. Any interloop adhesions were carefully divided and the gauze-wiping maneuver was used to soak up the residual peritoneal fluid, and all bowel loops were investigated to the root of the mesentery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short-term outcome with wound infection, pneumonia, leakage, and intraabdominal abscess | Complication grading used clavien dindo classification | Through hospitalization, an average of 8 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Laparoscopic surgery, Perforated peptic ulcer, Peritoneal irrigation, Gauze wiping and suction, Intra-abdominal abscess