Hirotaka Sasada, PhD1, Fuminori Wakayama1, Kohji Nagao1, Tadashi Iwabuchi1, Nobuo Yagihashi1, Shunnichi Takaya1, Junzo Nagayama2. 1Tsugaru General Hospital, 2Tokiwakai Hospital
Introduction: Upper gastrointestinal perforation usually requires emergency management and surgery; laparoscopic surgery is the first choice for such cases. Here we present a report on the treatment strategy used at our department.
Subjects: The subjects comprised 34 patients who were admitted to our department between October 2012 and January 2016.
Results: There were 13 cases of gastric perforation, 17 of duodenal perforation, and four of perforation of an unknown origin. All cases of duodenal perforation were due to ulcers, whereas 11 cases of gastric perforation were due to ulcers and two were due to cancer. The cause of three of the four cases of perforation of an unknown origin was unclear either because of the indications for surgery not being met or the patient dying as a result of refusing surgery. One out of the four cases of perforation of an unknown origin underwent laparotomy; however, the site of perforation could not be detected. Surgery was performed on 25 of the 34 patients, and nine patients were conservatively treated. Among the 25 patients who underwent surgery, 22 were treated with an omental pedicle flap or patch, two with drainage, and one with exploratory laparotomy. Laparoscopic surgery was performed on 13 out of the 22 patients who were treated with an omental pedicle flap or patch, and laparotomy was performed on the remaining nine patients. The mean duration of laparotomy was significantly shorter than that for laparoscopic surgery (73.1 vs. 94.4 min). The mean volume of blood loss was lower during laparoscopic surgery than that during laparotomy (6.5 vs. 26.0 mL). There were no significant differences in the mean length of postoperative hospital stay between laparoscopic surgery and laparotomy (32.0 vs. 69.0 days). Excluding patients who died, the duration of hospital stay in the conservatively treated cases was significantly shorter at 16.8 days compared to that in cases treated using laparotomy.
Conclusion: More than half of upper gastrointestinal perforation cases were treated by laparoscopic surgery at our department, suggesting that laparoscopic surgery represents an effective emergency surgical procedure. The duration of hospital stay was shortest in the conservatively treated cases and longest in the laparotomy cases. Therefore, our departmental treatment strategy is to conservatively treat patients whenever possible and follow the laparoscopic procedure when surgery is indicated.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77885
Program Number: S105
Presentation Session: Acute Care Surgery
Presentation Type: Podium