Repair Of Gastric Perforation Research Articles

Cation-π Interaction-Enhanced Self-Healing Injectable Hydrogels for Gastric Perforation Repair.

Surgical operations are the preferred treatment for gastric perforation (GP) but incur postoperative complications such as gastrointestinal adhesions and bacterial infections, leading to inefficient wound healing and serious complications that may even threaten the life of the patient. Developing hydrogel dressings capable of adapting to the gastric environment (acid) and decreasing visceral adhesions and bacterial infections after GP treatment is crucial. In this article, we developed an injectable, self-healing hydrogel using cation-π interactions between protonated amines and aromatic rings under acidic conditions and explored it for GP repair. The hydrogels demonstrate exceptional self-healing capabilities under acidic conditions and can be effectively tailored for the gastric environment. In addition, the hydrogel demonstrated significant efficacy in preventing gastrointestinal adhesion, reducing inflammation, promoting angiogenesis, and effectively facilitating wound healing in a rat GP model. This novel hydrogel demonstrates adaptability to the gastric environment, rendering it highly promising for potential applications in gastric trauma healing.

Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis

BackgroundGastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. MethodsWe conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education–accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. ResultsBetween 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and “other major stomach procedures” (P < .05 for all comparisons).Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). ConclusionThere has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.

Analyzing Mushroom Structural Patterns of a Highly Compressible and Expandable Hemostatic Foam for Gastric Perforation Repair.

Nature presents the most beautiful patterns through evolving. Here, a layered porous pattern in golden ratio (0.618) is reported from a type of mushroom -Dictyophora Rubrovalvata stipe (DRS). The hierarchical structure shows a mathematical correlation with the golden ratio. This unique structure leads to superior mechanical properties. The gradient porous structure from outside to innermost endows it with asymmetrical hydrophilicity. A mathematical model is then developed to predict and apply to 3D printed structures. The mushroom is then explored to repair gastric perforation because the stomach is a continuous peristaltic organ, and the perforated site is subject to repeated mechanical movements and pressure changes. At present, endoscopic clipping is ineffective in treating ulcerative perforation with fragile surrounding tissues. Although endoscopic implant occlusion provides a new direction for the treatment of gastric ulcers, but the metal or plastic occluder needs to be removed, requiring a second intervention. Decellularized DRS (DDRS) is found with asymmetric water absorption rate, super-compressive elasticity, shape memory, and biocompatibility, making it a suitable occluder for the gastric perforation. The efficacy in blocking gastric perforation and promoting healing is confirmed by endoscopic observation and tissue analysis during a 2-month study.

A Janus hydrogel sealant with instant wet adhesion and anti-swelling behavior for gastric perforation repair

Achieving instant adhesion on wet tissues and preventing the concurrently occurred postoperative tissue adhesion remain tough challenges but urgently demanded. And the deteriorated cohesion and adhesion caused by undesired swelling of hydrogel could not be ignored. Herein, we developed a Janus hydrogel with instant wet adhesion and anti-swelling behavior, based on poly (acrylic acid) (PAA), gelatin (GT) and hyperbranched polymers modified with catechol (HBPC). The asymmetric structure is achieved through complexed one-side of the hydrogel with cationic polymers. The strong physical interaction between PAA and GT formed during immersing in water enhanced the mechanical strength of the gels. And the hydrogel exhibits good anti-swelling behavior, which circumvents the limitations of conventional hydrogel caused by swelling. Water drainage induced by hydrophobic component and the following removal of water residuals achieved by hydrophilic PAA synergistically enhanced the instant wet adhesion of the hydrogel. Besides, pH-responsive protonation of carboxyl groups in PAA equipped the adhesive with extreme acid-tolerance. The in vivo evaluation results demonstrated that the asymmetric adhesive hydrogel could promote the repair of gastric perforation while reducing the risk of postoperative tissue adhesion. The hydrogel with asymmetric wet adhesion might provide valuable insights into the establishment of bioadhesives for gastric sealing and repair.

МИНИИНВАЗИВНЫЕ ТЕХНОЛОГИИ В ЛЕЧЕНИИ ОСЛОЖНЕНИЙ ОСТРОГО ПАНКРЕАТИТА

Abstract. Introduction. Hollow organ perforations accompanying pancreatic necrosis are a severe complication. In this case, surgical intervention is limited to a degree due to the extensive process in the upper abdomen and the patient’s functional condition. Aim. To share our experience in the minimally invasive repair of gastric perforation in a case series of severely infected pancreatic necroses and retroperitoneal phlegmons. Materials and Methods. We analyzed a case series in our clinic over 5 years, including the necrotizing forms of acute pancreatitis with complications, such as acute perforations of hollow organs. This paper describes the minimally invasive surgeries we performed to treat perforations in upper abdominal. Results and Discussion. In 3 of 4 cases in our clinic, acute perforations of the upper gastrointestinal tract developed along with necrotizing pancreatitis were successfully released using the minimally invasive approach. Conclusions. Hollow organ perforation is one of the most severe complications of infected pancreatic necrosis resulting from the aggressive effects of pancreatic secretion. In this case, the tactical approach depends on the nature and localization of perforation, the course of pancreatic necrosis, and the patient’s functional condition. For perforation of acute gastric ulcers, it is technically possible to use a minimally invasive approach using endoscopic clips, which has been successfully demonstrated in our clinic. We hope that our experience will allow avoiding extended operations in this category of patients.

Wound healing of gaster perforation with Human Dried Amniotic Membrane (H-DAM) as biomaterial patch viewing from the fibroblasts counts and collagen density

Link of Video Abstract: https://youtu.be/UldBMnzIelE Background: Gastric perforation in neonates is an emergency in neonatology with a mortality rate of up to 75%. Many studies have been carried out to improve tissue healing, including using various surgical techniques and materials, one of which is using H-DAM technology. Therefore, this study aims to evaluate the differences in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biomaterial patch compared to using an omental patch in New Zealand white rabbits. Methods: A true-experimental study was conducted among 30 samples of rabbits and none of them dropped out. The inclusion criteria for this study are New Zealand White Rabbit male sex, age 6-9 months with a weight of 2-3 kg, healthy and active. The Exclusion criteria for this study are rabbits not fasted for 12 hours. During the 12-hour fasting period, it behaved aggressively, attacked other rabbits, and found surgical site infection. Data were analyzed using SPSS version 25.0 for Windows. Results: From the examination results, there was a significant difference in gastric healing in terms of examining the number of fibroblasts with the Kruskal-Wallis test (p=0.000. The One-way ANOVA analysis found that the three data groups had no significant difference (p=0.234). Conclusion: There is an increase in the number of fibroblasts and collagen density in gastric perforation repair with H-DAM as a biological dressing compared to primary repair of gastric perforation using an omental patch in rabbit models so that H-DAM can be the repair technique of choice in gastric perforation in the rabbit.

Nano-enabled DNA supramolecular sealant for soft tissue surgical applications

Bioadhesives or sealants have received considerable attention for suture-less wound sealing. However, most adhesive biomaterials involve complex molecular designs which lack dynamic mechanical properties, inherent hemostasis, as well as the capability of preventing postsurgical tissue adhesion. Herein, a nano-enabled supramolecular hydrogel sealant based on complementary DNA duplexes combined with multiple physicochemical crosslinks is designed and demonstrated. This supramolecular sealant exhibits excellent dynamic reversibility, low swelling, and wet adhesive properties. It can achieve rapid sealing of damaged tissues, blood coagulation, as well as hemostasis. Furthermore, DNA molecules endow the sealant with promising capabilities of preventing protein absorption, cell adhesion and postsurgical tissue adhesion. The in vivo evaluation based on the gastric perforation repair model shows that the sealant can improve granulation tissue growth, collagen deposition, and vascularization and facilitate gastric perforation closure. The nano-enabled DNA supramolecular hydrogel sealant represents a promising alternative for gastric perforation repair and has large clinical potential pertaining to suture-less repair of soft tissues. Data availabilityThe data reported in this manuscript are available upon request.

Evisceration of intestines with diaphragmatic laceration and gastric perforation secondary to trauma by rhinoceros attack and its management: a case report.

A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh. There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio. Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status. Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.

Upper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century.

Upper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century.

Observation and Nursing of Patients with Recurrent Perforation After Gastric Perforation Repair

Observation and Nursing of Patients with Recurrent Perforation After Gastric Perforation Repair

Robust hydrogel adhesives for emergency rescue and gastric perforation repair.

Development of biocompatible hydrogel adhesives with robust tissue adhesion to realize instant hemorrhage control and injury sealing, especially for emergency rescue and tissue repair, is still challenging. Herein, we report a potent hydrogel adhesive by free radical polymerization of N-acryloyl aspartic acid (AASP) in a facile and straightforward way. Through delicate adjustment of steric hindrance, the synergistic effect between interface interactions and cohesion energy can be achieved in PAASP hydrogel verified by X-ray photoelectron spectroscopy (XPS) analysis and simulation calculation compared to poly (N-acryloyl glutamic acid) (PAGLU) and poly (N-acryloyl amidomalonic acid) (PAAMI) hydrogels. The adhesion strength of the PAASP hydrogel could reach 120 kPa to firmly seal the broken organs to withstand the external force with persistent stability under physiological conditions, and rapid hemostasis in different hemorrhage models on mice is achieved using PAASP hydrogel as physical barrier. Furthermore, the paper-based Fe3+ transfer printing method is applied to construct PAASP-based Janus hydrogel patch with both adhesive and non-adhesive surfaces, by which simultaneous wound healing and postoperative anti-adhesion can be realized in gastric perforation model on mice. This advanced hydrogel may show vast potential as bio-adhesives for emergency rescue and tissue/organ repair.

Hydrogel Bioadhesives with Extreme Acid‐Tolerance for Gastric Perforation Repairing

AbstractHydrogel bioadhesives have emerged as one of the most promising alternatives to sutures and staples for wound sealing and repairing, owing to their unique advantages in biocompatibility, mechanical compliance, and minimally invasive manipulation. However, only a few hydrogel bioadhesives have been successfully used for gastric perforation repair, due to their undesirable swelling when in direct contact with extremely acidic gastric fluids, and are thereby accompanied by a gradually deteriorating adhesion performance. Herein, an acid‐tolerant hydrogel (ATGel) bioadhesive is developed, which integrates two distinct components, an acid‐tolerant hydrogel substrate and an adhesive polymer brush layer. The ATGel bioadhesive can form instant, atraumatic, fluid‐tight, and sutureless sealing of gastric perforation, and enable robust biointerfaces in direct contact with gastric fluids, addressing the key limitations with sutures and commercially‐available tissue adhesives. Moreover, in vivo investigation on gastric perforation of rat model validates the proposed acid‐tolerant bioadhesion, and identifies the mechanisms for accelerated gastric perforation repair through alleviated inflammation, which suppresses fibrosis and enhances angiogenesis.

Gastric Tumor Perforation Repair with Falciform Ligament

The rate of perforation in gastric tumors has been reported to be between 0.5 and 3.9%. Because the tumor is not diagnosed at the moment, or the tumor's stage is unknown, repairing the perforation site is recommended rather than resection. The first thing that comes to mind as a repair method is omentoplasty, but other alternatives can be applied in cases where this is not possible. In our case report, we aimed to present gastric tumor perforation repair with a falciform ligament in a case of linitis plastica under chemotherapy accompanied by peritoneal carcinomatosis.

Delayed laparotomy and gastric repair in gastric perforation: a case report in the neonatal patient

Background: The incidence of gastric perforation in neonates is rare but has a high mortality rate of 15-70%. Spontaneous gastric perforation in neonates is estimated to occur in one of 2,900 live births and accounts for approximately 7% of all gastrointestinal perforations in neonates and children.Case: We present a case of gastric perforation complicated by sepsis, anemia, thrombocytopenia, and hypoalbuminemia in a 3-day-old girl. The patient was brought to the emergency room of Dr. Soetomo Hospital Surabaya with blood vomiting complaints from 1 day. On physical examination, it was found that the general condition was weak, with an axillary temperature of 38.2° C. The abdomen looked distended from inspection of the abdominal region, with the dilated vein and periumbilical hyperemia. Its percussion revealed the loss of liver dullness. The results of laboratory examinations: Hb 10.7 g/dl, Platelet 14,000/mm3, Albumin 2,6 g/dl. Plain thoracoabdominal X-Ray study showed a pneumoperitoneum. Needle decompression was performed because there were signs of Abdominal Compartment Syndrome (ACS). After five days of optimization in the Intensive Care Unit, a laparotomy exploration and primary repair of gastric perforation were conducted.Conclusion: Gastric perforation in neonates is a rare condition. The management principle for each patient is different depending on the patient's condition. Needle decompression is indicated when ACS is present or the patient's condition is not optimal for surgery. Definitive laparotomy can be done after the patient's condition has been stabilized. Proper selection of treatment can improve the patient's outcome and reduce the risk of morbidity and mortality.

The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study

Objective Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model. Methods Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment. Results Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups. Conclusion DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.

Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation

Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.

Decellularized gastric matrix as a mesh for gastric perforation repair.

The development of novel materials with effective defect-repairing properties will help avoid subtotal gastrectomy in patients with large gastric perforations. We prepared perfused decellularized gastric matrix (PDGM) and analyzed its components, spatial structure, biomechanics, cytotoxicity, and histocompatibility to validate its efficacy in the repair of gastric perforation. PDGM retained large amounts of gastric extracellular matrix, while residual glandular cells and muscle fibers were not found. The spatial structure of the tissue was well preserved, while the DNA and glycosaminoglycan contents were significantly decreased compared with normal gastric tissue (p < .01). There was no obvious deformation of the spatial structure and tissue elasticity of PDGM after sterilization by Cobalt-60 irradiation. The PDGM had good histocompatibility. PDGM was then used to repair a rat gastric perforation model. Radiography of the upper gastrointestinal tract at 24 hr postoperatively revealed no contrast agent leakage. There was evidence of early fibroblast proliferation, which was complicated by capillary regeneration. The hyperplastic gastric gland was slightly disarranged after repair. Defects of the muscular layer also healed a little with the regeneration process. PDGM is a nontoxic biocompatible biological mesh that may be useful for repairing relatively large gastric defects.

Endoscopic Repair of Large Gastric Perforation Following Pneumatic Dilation of Sleeve Gastrectomy Stenosis.

Sleeve gastrectomy has become the most commonly performed bariatric surgery in the USA (English et al.in Surg Obes Relat Dis. 14(3):259-63, 2018). Despite the rising popularity of this procedure, gastric stenosis is a known complication with an incidence of up to 4% (Rebibo et al. in Obes Surg. 26(5):995-1001, 2016). Endoscopic pneumatic balloon dilation is increasingly utilized to treat this condition and to ameliorate symptoms of nausea, vomiting, reflux, and/or dysphagia (Dhorepatil et al. in BMC Surg. 18(1):52, 2018). Pneumatic balloon dilation does carry a risk of gastric perforation of up to 3% in the limited literature to date (Donatelli et al. in Surg Obes Relat Dis. 13(6):943-50, 2017), historically requiring immediate surgical consultation for repair (Donatelli et al. Surg Obes Relat Dis. 13(6):943-50, 2017). In this case series, two cases of gastric perforation during pneumatic dilation for gastric sleeve stenosis were repaired successfully endoscopically with use of an endoscopic suturing system, resulting in correction of gastric defect and elimination of symptoms.

PUNCTURE FROM A TOOTHPICK: AN ATYPICAL PRESENTATION OF PYLEPHLEBITIS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Septic thrombophlebitis comprises of a spectrum of venous thrombi arising as a sequelae of inflammation in the setting of bacteremia. Pylephlebitis describes a septic thrombophlebitis involving the portal vein. We report a unique case of pylephlebitis resulting from endovascular foreign body perforation of the gastric wall. CASE PRESENTATION: A 69 year old female presented to our Emergency Department with 1 week of progressive abdominal pain, bloating and anorexia complaining of dark stools. She was noted to have sepsis and was started on broad spectrum antibiotics. Workup for sepsis revealed gastric antral thickening (Figure 1). Subsequent esophagogastroduodenoscopy (EGD) showed a toothpick perforating the gastric antral wall (Figure 2). Despite of removal, she continued to have abdominal pain and fever, prompting repeat CT abdomen. It showed infected portal venous, superior mesenteric venous (SMV) thrombus and portal venous gas (Figure 3). Blood cultures grew Streptococcus anginosus and Rothia mucilaginosa. Despite appropriate antibiotics, she developed septic shock and DIC, prompting another CT abdomen revealing a 1.4 cm abscess adjacent to the left anterolateral aspect of the SMV, thrombosis of the left portal vein with extensive portal venous air in the left lobe consistent with septic thrombophlebitis of the superior mesenteric vein and portal venous system (Figure 4). She was taken to OR for exploratory laparotomy, repair of gastric perforation, abdominal abscess drainage, portal vein thrombolysis. She was started on anticoagulation and was given extended course of antibiotic therapy at discharge. DISCUSSION: Pylephlebitis describes a septic thrombophlebitis involving the portal vein. The etiology of pylephlebitis is the pathophysiologic development of localized pockets of inflammation as an humoral immune response to an infection. Thrombophlebitis in small veins either embolize or extend into larger downstream veins, coalescing into the apogee of a portal vein thrombosis. While most cases involve thrombosis involving the SMV (42%), involvement of intrahepatic branches of the portal vein (39%) and the splenic vein (12%) is common. Pylephlebitis may arise from intra-abdominal or pelvic infection through direct downstream sequelae caught in the portal system. While of cases of pylephlebitis occur more commonly in the setting of diverticulitis, pylephlebitis remains a rare complication. Due to the paucity of data regarding pylephlebitis, it is difficult to assert that there is any greater association with extragastric complications when compared to other abdominal disease states. Gastric perforation from tooth pick with secondary pylephlebitis is a very unique clinical presentation. On review of available literature, only one case similar case was found. CONCLUSIONS: Physicians should have a high index of suspicion in cases of intra-abdominal pathology who remain unstable. Reference #1: Kanellopoulou T, Alexopoulou A, Theodossiades G, et al. Pylephlebitis: an overview of non-cirrhotic cases and factors related to outcome. Scand J Infect Dis 2010; 42:804. Reference #2: Plemmons RM, Dooley DP, Longfield RN. Septic thrombophlebitis of the portal vein (pylephlebitis): diagnosis and management in the modern era. Clin Infect Dis 1995; 21:1114. Reference #3: Peters, Thomas G., et al. “Suppurative Pylephlebitis Caused by Toothpick Perforation.” Southern Medical Journal 1988; 81:414-415. https://doi.org/10.1097/00007611-198803000-00034. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Brian Boden, source=Web Response No relevant relationships by Rajeev Fernando, source=Admin input No relevant relationships by Steve Georgopoulos, source=Admin input No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Najia Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by ahsan khan, source=Web Response No relevant relationships by Paul Poidomani, source=Web Response No relevant relationships by Richard Ricca, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Amanda Stashin, source=Web Response

Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation

Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.