We find some serious problems with the retrospective study of Lee et al from Hong Kong regarding its methodology and interpretations. The Boey score and its measurement are poorly defined. We are told that since 1995 patients were subjected to laparoscopic repair "unless the surgeon or the anesthetist considered the patient not suitable," but the criteria used to make such a decision are not given. We learn that leakage after simple closure accounted for only 3 of the 15 deaths. In the absence of routine postoperative contrast or computed tomographic studies, reexplorations, or autopsies, this figure has to be a pure guess. Fifteen patients died of "sepsis with multiorgan failure," but the cause is not provided. Was it a nonidentified leak?
Moshe Schein, Leslie Wise. Predicting Mortality and Morbidity of Patients Operated on for Perforated Peptic Ulcers—Invited Critique. Arch Surg. 2001;136(1):94. doi:10.1001/archsurg.136.1.94