Surgical Management of Perforated Peptic Ulcer; Closure with Omental Patch versus Definitive Repair with Vagotomy and Gastrojejunostomy: A Comparative Study

Loay M Gertallah,Marwan N Elgohary,Gamal Osman,Ahmed S Allam,Walid A Mawla,Heba F Tantawy,Ibrahim A Heggy,Ahmed M Elsayed

doi:10.4236/ss.2019.109035

Abstract

Background: The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer; performing simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer (closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy to discover a proper management strategy of perforated peptic ulcer. Patients and Methods: In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy. Results: We found that younger patient underwent vagotomy and gastro-jejunostomy technique (p H. pylori infection and inhibition of acid secretion especially in old patients with comorbid condition who presented late or with shock.

Highlights

The perforation of peptic ulcer is a common and serious life threatening surgical emergency
The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer; performing simple closure of the perforation with an omental patch H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer
Patients and Methods: In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy

Summary

Introduction

The perforation of peptic ulcer is a common and serious life threatening surgical emergency. It was previously stated that definitive surgical management of the perforated ulcer could be performed if there was a minimal contamination of the upper abdomen and the patient was stable having no severe co-morbid conditions. This definitive surgical management includes vagotomy and gastro-jejunostomy [5] [6]. Due to recent advances in medical anti-ulcer therapies, closing the perforation site using omental patch which is followed by H. pylori eradication and inhibition of acid secretion by proton pump inhibitors are safe and easy options which changed the past concept of using truncal vagotomy and drainage procedures [7].

Objectives

Methods

Discussion

Conclusion