Abstract
Ulcer disease remains the most common cause of gastroduodenal perforation, with an incidence between 2% and 10% in patients with ulcers. With the advent of proton pump inhibitors(PPI) the surgery for perforated peptic ulcer has changed from perforation closure with definitive acid reduction surgeries to simple omental patch. The trend of minimal is better holds good. With advances in laparoscopic surgery and its application in emergency abdominal conditions it has been shown feasible for management of perforated peptic ulcer. Though there have been various studies showing successful nonoperative management of perforated peptic ulcer, Conservative treatment has not gained widespread acceptance as an alternative approach to surgery. The reason being lack of uniform selection criteria and management guidelines for conservative management. This review article aims at introducing an algorithm approach towards successful non operative management of perforated peptic ulcer.
Highlights
Ulcer disease remains the most common cause of gastroduodenal perforation, with an incidence between 2% and 10% in patients with ulcers.[1]
With the advent of proton pump inhibitors (PPI) the surgery for perforated peptic ulcer has changed from perforation closure with definitive acid reduction surgeries to simple omental patch
With advances in laparoscopic surgery and its application in emergency abdominal conditions it has been shown feasible for management of perforated peptic ulcer
Summary
Ulcer disease remains the most common cause of gastroduodenal perforation, with an incidence between 2% and 10% in patients with ulcers.[1] Despite dramatic improvements in peptic ulcer management in the last two decades (new potent anti-secretory drugs as well as Helicobacter pylori eradication)[2], the frequency of perforated gastroduodenal ulcer has remained stable or even increased[3]. Though there have been various studies showing successful nonoperative management of perforated peptic ulcer, Conservative treatment has not gained widespread acceptance as an alternative approach to surgery. Conservative treatment has not gained widespread acceptance as an alternative approach to surgery for perforated gastroduodenal ulcer It was developed at a time when surgical closure was associated with high mortality[10]. There were no uniform selection criteria and management guidelines which led to varied results of conservative management with high failure rates
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