Omental Patch Research Articles

Surgical outcome of management of perforated peptic ulcer: retrospective analysis of 148 cases

Background: Perforated peptic ulcer (PPU) is a common life threatening surgical emergency. Discovery of H. pylori (1985) changed the concept of the management of peptic ulcer. Now-a-days reduction in gastric acid production with proton pump inhibitors along with eradication of H. pylori is recommended.Methods: Clinically suspected cases of PPU were confirmed by radiological and laboratory investigation. These patients were subjected to exploratory laparotomy with Graham’s omental patch repair after adequate fluid resuscitation with optimal hemodynamic status with or without peritoneal drainage, except in too sick patients. Postoperatively; these patients kept in SICU and closely monitored. Data were collected, tabulated and analyzed.Results: Out 150 cases enrolled, 2 cases died before exploratory laparotomy and closure of operation. So only 148 took part in the study. Male patients were predominant than female in a ratio of 148:2. Age ranges from 20 to >60 years. Majority of the patients belongs to the age group 30-40 years of age. The morbidity and mortality rates were 20% and 2.7% respectively.Conclusions: Adequate fluid resuscitation with optimal hemodynamic status and optimal kidney function is the key to decrease morbidity and mortality rates. Simple closure with omental patch followed by H. pylori eradication is effective with excellent outcome in most of survivor despite of late presentation. Old concept of prophylactic peritoneal drainage and “no sunset no sun rise” concept of operation should be discouraged as it is not beneficial. Definitive surgery for ulcer recurrence is no more done except in special situation.

Perforated Gastric Cancer: A Systematic Review.

Background: Although gastric carcinoma is the fifth most commonly diagnosed cancer, optimal treatment of perforated cancer remains debated. Materials and Methods: The study was conducted according to the guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. An electronic systematic search was conducted using MEDLINE databases (PubMed, EMBASE, and Web of Science) by matching the terms "perforated gastric cancer," "gastric cancer perforated," "perforation AND gastric cancer," and "perforated gastric tumor." Results: Fifteen studies published between 1995 and 2018 and including 964 patients matched the inclusion criteria for this systematic review. There were 4 publications from Japan, 3 from Turkey, and 1 from China, Germany, Hong Kong, Italy, Nepal, Serbia, South Korea, and Taiwan, respectively. The sample size of the individual studies ranged from 8 to 514 patients. Perforated gastric carcinoma was rare and more prevalent in elderly males, preoperative diagnosis was uncommon, and the distal stomach was most frequently involved. Mortality was 11.4% and 1.9%, respectively, in one-stage versus two-stage gastrectomy (P = .010). Curative treatment by omental patch repair and staged gastrectomy yielded acceptable 5-year survival rates. There were no significant differences in the recurrence rate and pattern between perforated and nonperforated gastric cancer if a curative operation was performed. Use of laparoscopy was mentioned only in one study. Conclusions: Future studies should evaluate the role of laparoscopic surgery and clarify the indications for hyperthermic intraperitoneal chemotherapy and extensive peritoneal lavage protocols to decrease gastric cancer cell shed in the surgical field and increase long-term survival.

Laparoscopic omental patch for perforated peptic ulcer disease reduces length of stay and complications, compared to open surgery: A SWSC multicenter study

RCTs showed benefits in Lap repair of perforated peptic ulcer (PPU). The SWSC Multi-Center Trials Group sought to evaluate whether Lap omental patch repairs compared to Open improved outcomes in PPU in general practice. Data was collected from 9 SWSC Trial Group centers. Demographics, operative time, 30-day complications, length of stay and mortality were included. 461 PATIENTS: Open in 311(67%) patients, Lap in 132(28%) with 20(5%) patients converted from Lap to Open. Groups were similar at baseline. Significant variability was found between centers in their utilization of Lap (0-67%). Complications at 30 days were lower in Lap (18.5% vs. 27.5%, p < 0.05) as was unplanned re-operation (4.7% vs 14%, p < 0.05). Lap reduced LOS (6 vs 8 days, p < 0.001). Ileus was more in Lap (42% vs 18 p < 0.001) operative time was 14 min higher in Lap(p < 0.01) and admission to OR time was 4 h higher in Lap(<0.05). No significant difference readmission or mortality. Our results suggest Lap should be considered a first-line option in suitable PPU patients requiring omental patch repair in centers that have the capacity and resources 24/7.

Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008-2018).

To determine the influence of oversewing a transverse staple line in functional end-to-end stapled intestinal anastomoses (FEESA) in dogs. Retrospective observational study. Seventy-seven client-owned dogs that underwent 78 FEESA reinforced (n = 30) or not reinforced (n = 48) with suture at the transverse staple line. The medical records database was searched and reviewed for dogs that had undergone a FEESA between January 2008 and September 2018. Data were collected regarding signalment, body weight, clinical presentation, indication for surgery, serum albumin, presence of septic peritonitis, previous surgeries, surgical techniques (ie, oversew, crotch suture, omental wrap, omental patch, serosal patch), histopathology results, and postoperative outcome. The only differences identified between groups consisted of higher preoperative albumin (2.89 ± 0.56 vs 2.34 ± 0.62 g/dL; P = .006) and lower postoperative dehiscence rate (0/30 vs 7/48; P = .028) in dogs with an oversewn FEESA. Oversewing the FEESA was identified as the significant factor in a model with oversewing and preoperative albumin fit to the outcome of dehiscence (oversew P = .010, albumin P = .761). The location of the dehiscence was specified in four of seven dogs, all along the transverse staple line. Patterns used for oversew were unspecified (n = 11), simple continuous (8), Cushing (4), simple interrupted (2), cruciate (1), interrupted horizontal mattress (1), and Lembert (1). Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence. Our results provide evidence to support additional investigation of suture reinforcement (oversewing) at the transverse staple line of FEESA to reduce postoperative dehiscence.

Sleeve Gastrectomy with Intra-operative Endoscopic Guidance

Purpose: To assess the advantage of using intraoperative endoscopic guidance during sleeve gastrectomy and its efficiency to decrease various complications. Methods: This was a retrospective study at Ain shams specialized hospital and Cure hospital. Patients who had sleeve gastrectomy with intra-operative endoscopic guidance were included in this study. Results: From September 2017 to February 2019, 226 patients had LSG as a definitive bariatric procedure. All the procedures were done with intra-operative endoscopic guidance. Seventy nine percent were female with a mean age of 39.7±14 years (range 23–49 years) and a mean body mass index of 48.6±14 kg/m2 (range 41–59 kg/m2 ). Two cases showed intraoperative leak that was managed intraoperatively by over suturing and omental patch. One case showed mild twisting at the incisura angularies that was managed intraoperatively by fixing the twisted angle to the retroperitoneum. Marked internal bleeding from the staple line was seen in two cases; which necessitated endoscopic clip insertion in one case and epinephrine injection for the other. The average length of the hospital stay was 1.8 days post operatively. The post-operative leakage was 0% and no cases had obstructive symptoms. Conclusion: Sleeve gastrectomy surgery with endoscopic guidance is very important not only to calibrate the size of the gastric pouch instead of the bougie, but also to prevent various complications as gastric obstruction or bleeding or even fatal complications as gastric leak

Laparoscopic one-anastomosis gastric bypass: results of the first 310 patients

Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed. Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery. Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomotic stenosis needed dilatation over three sessions. One patient developed port site hernia 6 months postoperatively. This patient was explored and managed laparoscopically. One patient presented 15 months after minigastric bypass with perforated gastrojejunal anastomotic ulcer that was treated by omental patch repair. There were no postoperative mortalities. Conclusion LOAGB can be regarded as a simple, safe, effective, and reversible bariatric procedure.

Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

Introduction and hypothesisThe use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally. Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery.MethodsA prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan–Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months’ follow-up).ResultsNinety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0–62.1). Three mesh erosions were diagnosed (3.1%; Kaplan–Meier 4.9%, 95% confidence interval 0–11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0–13.3%).ConclusionsThe long-term rate of mesh erosion following an abdominally placed synthetic graft is low.

Postoperative hemorrhage complications following the Whipple procedure.

Although the Whipple operation is an essential surgical technique, its high morbidity (30% to 60%) and mortality (5%) are problems to be addressed. The incidence of postoperative hemorrhage has been reported between 5% and 16% in the literature. In this study, the data and results regarding postoperative hemorrhage complications from our clinic were evaluated. The files of 185 patients who had undergone Whipple operation in our hospital in the last five years were evaluated retrospectively, and the causes of hemorrhage were attempted to be determined. It was found that 6 out of the 13 (7%) patients who had hemorrhage died. In six of there 13 cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed in a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following the cessation of the drug. Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple operations. In addition to standard methods, angiography and embolization have emerged as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, determination and elimination of independent risk factors, such as jaundice, affecting fistula formation and bleeding in the perioperative period, is important for prevention.

Initial Experience with Endoscopic Pyloromyotomy, with Description and Video of Technique

BackgroundGastric per oral endoscopic myotomy (G-POEM) is a recently developed incisionless procedure to address gastroparesis. It has been previously described to treat medical and postsurgical gastroparesis. The present study is a case series of patients undergoing G-POEM for a variety of indications, both elective and urgent. MethodsIRB approval was obtained for retrospective review of a prospectively collected database including patients who underwent G-POEM during a 1.5-year period. Using an upper endoscope, a mucosotomy is made 2 cm proximal to the pylorus on the anterior surface of the stomach. A submucosal tunnel is made to the pylorus muscle, which is completed incised. When possible, Endoflip® was used to evaluate pyloric distensibility before and after the myotomy. Patient demographic factors, additional procedures, and other follow-up were collected by chart review. Elective cases were offered repeat gastric emptying study at 6 months. ResultsThere were 17 patients available for review. The procedure was technically completed in all cases. There was one gastric perforation recognized on postoperative day two that was addressed with laparoscopy and omental patch. Median length of stay was zero days, and 13/17 (76%) of patients experienced symptomatic relief. Pyloric distensibility significantly decreased intraoperatively from 5.6 (± 1.7) to 10.8 (± 5.0) cm2/mmHg (p = 0.002). ConclusionThis limited case series demonstrates G-POEM to be a versatile procedure able to address gastroparesis in a variety of settings. Success rates are congruent with previously published reports, and one serious complication was able to be addressed laparoscopically. Endoflip® was able to verify a successful myotomy intraoperatively. This procedure is an attractive alternative to less effective non-invasive treatments and a more invasive laparoscopic pyloroplasty.

Single institution experience treating adrenal metastases with stereotactic body radiation therapy.

The objective of the study is to present our experience of treating adrenal metastases using stereotactic body radiation therapy (SBRT). We retrospectively reviewed patients with adrenal metastases treated using SBRT from 2001 to 2014. Response Evaluation Criteria in Solid Tumors v1.1 was used. Maximum tumor response was defined as the greatest percentage tumor reduction noted on two or more post-SBRT CT scans. We identified 44 patients (median age 61.3 years, range: 25.8-85), with 54 adrenal metastases; primary diagnoses include non-small cell lung cancer (28 patients and 38 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (6 patients), and other (9 patients). Treatment was delivered in single (16 lesions, median dose 18 Gy [14-18]) or multiple fractions (38 lesions, median dose 30 Gy [16-40]). Median planning target volume was 49.65cc (3.21-984.54). Median response at first post-SBRT follow-up (median 1.65 months (m) (0.33-5.37), n = 46 lesions) was 10.8% with 91.3% local control. Median maximum tumor response was 31.8% (n = 32 lesions) at median follow-up of 5.4 m (0.9-44.8) with 96.6% local control. The response was comparable regardless of tumor histology or treatment fractionation. No patients experienced Grade 3/4 acute toxicities. One patient with a history of naproxen use required suturing with omental patch placement for perforated pyloric ulcer 14 m post-SBRT (18 Gy in single fraction) to the right adrenal metastasis; this region received <5 Gy. Ten patients treated for pain with available follow-up obtained relief. SBRT is a safe and efficacious treatment for adrenal metastases, demonstrating local tumor control. Further study of the impact on survival and quality of life is warranted.

Laparoscopic Repair of Perforated Marginal Ulcer After Roux-en-Y Gastric Bypass: A Case Report and Review of Literature

Introduction: A possible complication that may present late after Roux-en-Y gastric bypass is the development of marginal ulcer at the gastrojejunostomy site. We discuss here an emergency presentation of a case with a delayed perforation at the anastomosis 5 months after surgery which dealt successfully with the laparoscopic approach. Case Presentation: A 45-year-old female presented to the emergency department for evaluation of severe upper abdominal pain. Her past history was significant for laparoscopic Roux-en-Y gastric bypass surgery for weight loss done in Oct 2016 and further denied any history of chronic medication, alcoholism, smoking or any co-morbidity. She was examined and found to have a tenderness all over the abdomen with sluggish bowel sounds and decreased air entry at bases bilaterally, more so on the left side. Portable CXR revealed air under the diaphragm and an obliterated left costophrenic angle. A repeat CT scan with gastrograffin contrast was carried out and findings confirmed a perforation at the site of gastrojejunal anastomosis with free fluid in the pelvis and flanks. She underwent laparoscopic exploration and repair of anastomotic perforation with omental patch and was discharged in a healthy fashion on her 7th postoperative day. Conclusions: This case report corroborates with literature available from many sources that marginal ulcer perforation is one of the serious complications after Roux-en-Y gastric bypass and may present early in the first few months or as a delayed entity years after the surgery. Once diagnosed, urgent intervention is required and laparoscopic repair has shown itself a safe and effective treatment strategy where facilities are available.

LAPAROSCOPIC REPAIR OF PERFORATED DUODENAL ULCER PATCH VERSUS CONVENTIONAL SURGERY

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below. In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities.&#x0D; Keywords: Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

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

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.

A study on management and outcome of hollow viscus perforation at tertiary care hospital

An intestinal perforation is a major life-threatening condition with high morbidity and mortality that requires emergency surgery. Despite improvements in surgical and medical treatments, the overall mortality rate is 30% and the mortality rate of cases that also have diffuse peritonitis is up to 70%. The rate of postoperative complications, such as complicated fluid collection, leakage, surgical site infection, and other systemic infections, is higher than for patients receiving elective abdominal surgeries. In our study, 10 (37.1%) patients with Duodenum Perforation underwent immediate surgery while 17 (62.9%) patients underwent surgery on the same day. The mean time interval between admission and surgery of patients was 6.22 ± 3.39 hours. All patients (100%) with Appendicular Perforation underwent surgery on the same day. The mean time interval between admission and surgery of patients was 10.11 ± 2.93 hours. Simple closure with omental patch with thorough peritoneal toileting was very much effective.

Our First Two Cases of Endoscopic Ultrasound (EUS)-Guided Placement of Lumen-Apposing Metal Stent to Manage Acute Cholecystitis: Lessons Learned

For decades percutaneous gallbladder drainage (PGD) with systemic antibiotic therapy has been the mainstay, non-surgical treatment option for acute cholecystitis in high-risk operative candidates who failed conservative management. However, PGD has several complications that occur in up to 40% of patients. More recently EUS-guided gallbladder stenting (EUS-GBS) techniques have evolved whereby a stent is placed across the duodenal or gastric wall into the gallbladder thus avoiding a percutaneous drain. Early innovative strategies using biliary stents (either plastic or self-expanding metal) proved to be equally effective to PGD but were prone to the same complications as PGD and were technically difficult to perform thus EUS-GBS never gained widespread popularity. However, there is now an FDA-approved, fully-covered, self-expanding lumen-apposing metal stent (LAMS) with a cutting tip incorporated into the catheter for EUS-guided drainage of pancreatic pseudocysts. Research from high-volume referral centers indicates that LAMS may be equally suitable for transmural gallbladder drainage and appears to be simple to place. Thus far, at our institution we have attempted two cases of EUS-GBS using a LAMS in individuals with cholecystitis who were deemed to be poor-surgical candidates. In case #1 the patient's gallbladder was distended with innumerable shadowing gallstones (thus EUS views were limited) and attempt at EUS-GBS ultimately failed because the stent was erroneously deployed between the gallbladder and duodenal wall within a space created by the catheter. The patient underwent urgent cholecystectomy with omental patch closure of the iatrogenic duodenal perforation and did well. In case #2 a critically-ill patient who had undergone PGD but had recurrent episodes of sepsis related to drain dislodgement. On EUS this patient had a well-defined gallbladder that was distended and largely homogenous thus placement of the LAMS into the gallbladder across the duodenal wall was straightforward and technically successful. This patient was soon discharged home. Our first two cases of EUS-GBS with LAMS with a cutting tip incorporated into the catheter have taught us that this technique can be effective for emergent management of cholecystitis in poor-surgical candidates. However, gallbladders with heavy stone burden and/or a thick fibrotic wall may be more technically challenging.2165_A Figure 1 No Caption available.2165_B Figure 2 No Caption available.2165_C Figure 3 No Caption available.

A rare case of spontaneous gastric perforation in an adolescent

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.

Outcome of surgeries for non-traumatic hollow viscous perforations

Background: Patients with non-traumatic hollow viscous perforations present challenge to the surgeons and outcome depends upon location and surgeon skills. Present study was to investigate the outcome of surgeries for non-traumatic hollow viscous perforations.Methods: This is a prospective observational study carried out in surgical wards in Mamata General Hospital between October 2015 and September 2017 over a period of 02 years. Evaluation of all the patients fulfilling the inclusion and exclusion criteria with respect to history, physical findings, operative findings and postoperative complications in line with the predetermined objectives was done. Various treatment modalities available and their outcome were also evaluated.Results: Benign causes of gastrointestinal perforation constituted majority of non-traumatic gastrointestinal perforations. Peptic ulcer perforation (68%) was the major cause of gastrointestinal perforation. Most common site for non-traumatic gastrointestinal perforations was duodenum (48%). Simple closure with omental patch was the operative procedure done for all cases of peptic ulcer perforation and appendicectomy for appendicular perforation. Ileal perforations secondary to typhoid perforation were treated with resection and end-to-end anastomoses in the present study. Colonic perforation was managed with Hartmann’s procedure. Most common complication was SSI (34%). Mortality was 8% and was due to septicemia.Conclusions: Aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscous perforation cases.

Laparoscopic and open repair for perforated duodenal ulcer: single-center experience.

IntroductionPerforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery.AimTo analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer.Material and methodsThe study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group.ResultsIn 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3–14), in the open group 11.7 days (range: 6–63), and in the conversion group 9.3 days (8–10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014–2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010–2013).ConclusionsThe laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20–25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.

Omental Patch Repair for Duodenal Ulcer Perforation- Analysis of Factors Affecting Outcome: A Prospective Study

Omental Patch Repair for Duodenal Ulcer Perforation- Analysis of Factors Affecting Outcome: A Prospective Study

Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications. Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the department of Surgery Government Bangur Hospital, Pali, Rajasthan, India. Structured performa was prepared to obtained details of patients and ethical clearance from the institute was also taken prior to the study. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality.