Comparative outcomes of transumbilical three-port <i>versus</i> single-port laparoscopic surgery for acute perforated peptic ulcer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Gang , LI Dandan , SHEN Jian , YANG Peng , HUANG Shuoyang , HE Xuelai , ZHENG Minjiang , ZUO ZhongLin ,  HE Shan

Department of General Surgery, Chengdu Second People’s Hospital Affiliated to Sichuan University, Chengdu 610017, P. R. China;

Corresponding?author：

HE Shan, Email: 2642159166@qq.com

Keywords：

transumbilical three-port laparoscopic surgery; transumbilical single-incision laparoscopic surgery; acute peptic ulcer perforation

DOI：

10.7507/1007-9424.202503128

Video：

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Objective To compare clinical efficacy between transumbilical three-port laparoscopic surgery (TU-TPLS) and transumbilical single-incision laparoscopic surgery (TU-SILS) in repair of acute peptic ulcer perforation. Methods The patients with acute peptic ulcer perforation who underwent TU-TPLS or TU-SILS in Chengdu Second People’s Hospital Affiliated to Sichuan University from January 2022 to December 2024 were retrospectively collected, and then were divided into the TU-TPLS group and TU-SILS group. The operation time, postoperative 24 h incision pain score (visual analogue scale) , postoperative hospital stay, total hospitalization cost, incision scar score (Vancouver scar scale), comprehensive satisfaction, and postoperative complications were compared between the two groups. Results A total of 105 patients met the inclusion criteria were enrolled, comprising 50 patients in the TU-TPLS group and 55 patients in the TU-SILS. There were no statistically significant differences in baseline characteristics between the two groups, such as gender, age, body mass index, perforation site, perforation diameter, and Boey score (all P>0.05). Postoperatively, the TU-TPLS group demonstrated significantly lower visual analogue scale pain score at 24 h compared to the TU-SILS group [(2.34±0.63) score vs. (3.22±1.05) score, P<0.001] and significantly higher comprehensive satisfaction score [(7.60±0.86) score vs. (7.02±1.01) score, P=0.002]. However, no statistically significant differences were observed between the TU-TPLS group and TU-SILS group regarding operative time [(71.84±10.51) min vs. (69.78±7.98) min, P=0.257], postoperative hospital stay [(10.35±2.08) d vs. (9.96±1.75) d, P=0.310], or total hospitalization costs [(20 856.23±4 095.73) yuan vs. (19 988.83±2 933.43) yuan, P=0.212]. The incidence of umbilical wound infection was 1 case in the TU-TPLS group and 3 cases in the TU-SILS group (P=0.619). Postoperative residual intra-abdominal infection occurred in 2 cases in the TU-TPLS group and 1 case in the TU-SILS group (P=0.604). Incisional bleeding occurred in 0 case in the TU-TPLS group and 1 case in the TU-SILS group (P>0.999). Furthermore, there was no statistically significant difference in the scar assessment score between the TU-TPLS group and TU-SILS group [(3.11±1.13) score vs. (2.92±0.70) score, P=0.301] at the 2-month postoperative follow-up. Conclusions Both TU-TPLS and TU-SILS have achieved good therapeutic effects in treatment of acute peptic ulcer perforation. However, TU-TPLS has more advantages over TU-SILS. TU-TPLS causes milder incision pain, leads to higher patient satisfaction, and does not require special equipment.

Citation： XIAO Gang, LI Dandan, SHEN Jian, YANG Peng, HUANG Shuoyang, HE Xuelai, ZHENG Minjiang, ZUO ZhongLin, HE Shan. Comparative outcomes of transumbilical three-port versus single-port laparoscopic surgery for acute perforated peptic ulcer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1176-1180. doi: 10.7507/1007-9424.202503128 Copy

1.	沈劍濤, 王西剛, 凌新建, 等. 消化性潰瘍穿孔病人術后死亡危險因素分析及列線圖模型構建. 腹部外科, 2025, 38(2): 128-133.
2.	邱小琴. 奧美拉唑四聯療法輔助腹腔鏡手術對消化性潰瘍穿孔患者機體炎性反應及復發的影響. 臨床合理用藥, 2024, 17(7): 52-55.
3.	陳韜, 梁煒祺, 陳嘉文, 等. 單孔腹腔鏡胃癌手術的發展歷程與未來展望. 消化腫瘤雜志(電子版), 2023, 15(2): 114-119.
4.	吳衛東, 張一忠, 王廷峰, 等. 單孔腹腔鏡腹股溝疝手術規范化操作中國專家共識(2023版). 中國實用外科雜志, 2023, 43(1): 34-47.
5.	Keller DS, Reif de Paula T, Ikner TP, et al. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: A comparative analysis in colorectal cancer surgery. Surg Endosc, 2024, 38(3): 1568-1575.
6.	Dapri G, El Mourad H, Himpens J, et al. Transumbilical single-access laparoscopic perforated gastric ulcer repair. Surg Innov, 2012, 19(2): 130-133.
7.	Lee J, Sung K, Lee D, et al. Single-port laparoscopic repair of a perforated duodenal ulcer: intracorporeal “cross and twine” knotting. Surg Endosc, 2011, 25(1): 229-233.
8.	Chae JK, Kim JH, Kim EJ, et al. Values of a patient and observer scar assessment scale to evaluate the facial skin graft scar. Ann Dermatol, 2016, 28(5): 615-623.
9.	劉海兵, 唐丹, 曹海燕, 等. 溫哥華瘢痕量表的信度研究. 中國康復醫學雜志, 2006, 21(3): 240-242.
10.	Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg, 1987, 205(1): 22-16.
11.	Nguyen TH, Dang TN, Schnelldorfer T. Single-port laparoscopic repair of perforated duodenal ulcers. World J Surg, 2020, 44(5): 1425-1430.
12.	喬明靜, 楊立, 徐臻, 等. 婦科經臍單孔腹腔鏡手術并發癥的預防及處理河南專家共識. 河南醫學研究, 2024, 33(23): 4225-4229.
13.	Murad MF, Khan R, Tariq M, et al. Laparoscopy: a better approach for perforated duodenal ulcer. Cureus, 2020, 12(10): e10953. doi: 10.7759/cureus.10953.
14.	鄭瑩, 熊光武, 劉娟, 等. 經臍單孔腹腔鏡手術臍部切口管理專家共識(2022年版). 實用婦產科雜志, 2022, 38(3): 192-197.
15.	王鵬, 郭青松, 凌長春. 單孔腹腔鏡手術后臍窩創面的簡單縫合術. 腹腔鏡外科雜志, 2016, 21(12): 958-960.
16.	Lee E, Lim D, Kang SH, et al. Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc, 2024, 38(2): 1106-1112.
17.	Lu Z, Chen Y, Xiao C, et al. Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons’ initial experience. BMC Surg, 2024, 24(1): 25. doi: 10.1186/s12893-023-02304-z.
18.	劉歡歡, 田雨, 吳碩東, 等. 經臍單孔腹腔鏡闌尾切除術治療急性闌尾炎的應用價值及經驗總結. 中國普外基礎與臨床雜志, 2018, 25(11): 1372-1374.
19.	肖剛, 于宏. 單孔腹腔鏡手術中肝臟牽拉方法的應用進展. 中國微創外科雜志, 2019, 19(1): 72-76.
20.	劉勇, 李大偉, 王永高, 等. 雙孔法與三孔法腹腔鏡十二指腸球部前壁潰瘍穿孔修補術的臨床比較. 中國普通外科雜志, 2015, 24(12): 1771-1774.
21.	Pang YF, Shu L, Xia CW. Retrospective comparative study of different surgical methods for gastric ulcer perforation: efficacy and postoperative complications. World J Gastrointest Surg, 2025, 17(2): 101896. doi: 10.4240/wjgs.v17.i2.101896.
22.	Kim TH, Park JH, Jeong SH, et al. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc, 2018, 32(8): 3667-3674.
23.	商瑩, 王宇男, 查恩華. 兩種不同臍部入路方式在單孔腹腔鏡闌尾切除術中的對比研究. 黑龍江醫學, 2024, 48(20): 2470-2472.

1. 沈劍濤, 王西剛, 凌新建, 等. 消化性潰瘍穿孔病人術后死亡危險因素分析及列線圖模型構建. 腹部外科, 2025, 38(2): 128-133.
2. 邱小琴. 奧美拉唑四聯療法輔助腹腔鏡手術對消化性潰瘍穿孔患者機體炎性反應及復發的影響. 臨床合理用藥, 2024, 17(7): 52-55.
3. 陳韜, 梁煒祺, 陳嘉文, 等. 單孔腹腔鏡胃癌手術的發展歷程與未來展望. 消化腫瘤雜志(電子版), 2023, 15(2): 114-119.
4. 吳衛東, 張一忠, 王廷峰, 等. 單孔腹腔鏡腹股溝疝手術規范化操作中國專家共識(2023版). 中國實用外科雜志, 2023, 43(1): 34-47.
5. Keller DS, Reif de Paula T, Ikner TP, et al. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: A comparative analysis in colorectal cancer surgery. Surg Endosc, 2024, 38(3): 1568-1575.
6. Dapri G, El Mourad H, Himpens J, et al. Transumbilical single-access laparoscopic perforated gastric ulcer repair. Surg Innov, 2012, 19(2): 130-133.
7. Lee J, Sung K, Lee D, et al. Single-port laparoscopic repair of a perforated duodenal ulcer: intracorporeal “cross and twine” knotting. Surg Endosc, 2011, 25(1): 229-233.
8. Chae JK, Kim JH, Kim EJ, et al. Values of a patient and observer scar assessment scale to evaluate the facial skin graft scar. Ann Dermatol, 2016, 28(5): 615-623.
9. 劉海兵, 唐丹, 曹海燕, 等. 溫哥華瘢痕量表的信度研究. 中國康復醫學雜志, 2006, 21(3): 240-242.
10. Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg, 1987, 205(1): 22-16.
11. Nguyen TH, Dang TN, Schnelldorfer T. Single-port laparoscopic repair of perforated duodenal ulcers. World J Surg, 2020, 44(5): 1425-1430.
12. 喬明靜, 楊立, 徐臻, 等. 婦科經臍單孔腹腔鏡手術并發癥的預防及處理河南專家共識. 河南醫學研究, 2024, 33(23): 4225-4229.
13. Murad MF, Khan R, Tariq M, et al. Laparoscopy: a better approach for perforated duodenal ulcer. Cureus, 2020, 12(10): e10953. doi: 10.7759/cureus.10953.
14. 鄭瑩, 熊光武, 劉娟, 等. 經臍單孔腹腔鏡手術臍部切口管理專家共識(2022年版). 實用婦產科雜志, 2022, 38(3): 192-197.
15. 王鵬, 郭青松, 凌長春. 單孔腹腔鏡手術后臍窩創面的簡單縫合術. 腹腔鏡外科雜志, 2016, 21(12): 958-960.
16. Lee E, Lim D, Kang SH, et al. Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc, 2024, 38(2): 1106-1112.
17. Lu Z, Chen Y, Xiao C, et al. Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons’ initial experience. BMC Surg, 2024, 24(1): 25. doi: 10.1186/s12893-023-02304-z.
18. 劉歡歡, 田雨, 吳碩東, 等. 經臍單孔腹腔鏡闌尾切除術治療急性闌尾炎的應用價值及經驗總結. 中國普外基礎與臨床雜志, 2018, 25(11): 1372-1374.
19. 肖剛, 于宏. 單孔腹腔鏡手術中肝臟牽拉方法的應用進展. 中國微創外科雜志, 2019, 19(1): 72-76.
20. 劉勇, 李大偉, 王永高, 等. 雙孔法與三孔法腹腔鏡十二指腸球部前壁潰瘍穿孔修補術的臨床比較. 中國普通外科雜志, 2015, 24(12): 1771-1774.
21. Pang YF, Shu L, Xia CW. Retrospective comparative study of different surgical methods for gastric ulcer perforation: efficacy and postoperative complications. World J Gastrointest Surg, 2025, 17(2): 101896. doi: 10.4240/wjgs.v17.i2.101896.
22. Kim TH, Park JH, Jeong SH, et al. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc, 2018, 32(8): 3667-3674.
23. 商瑩, 王宇男, 查恩華. 兩種不同臍部入路方式在單孔腹腔鏡闌尾切除術中的對比研究. 黑龍江醫學, 2024, 48(20): 2470-2472.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative outcomes of transumbilical three-port versus single-port laparoscopic surgery for acute perforated peptic ulcer

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