Treatment Of Perforated Peptic Ulcer Research Articles

Laparoscopic Repair Versus Open Repair for Perforated Peptic Ulcers: Quality of Life Assessment

PurposeThis study was designed to assess the relative efficacy of laparoscopic repair (LR) as opposed to open surgical repair (OR) in the treatment of perforated peptic ulcer (PPU) and its impact on quality of life. BackgroundStudies reporting patient-centered outcomes, including quality of life and satisfaction, in PPU treatment are insufficient. MethodsThis investigation performed a retrospective review of patients who underwent treatment for PPU at a secondary care hospital from December 2016 to November 2020. Patients were categorized into two separate groups according to the type of surgical procedure received: LR and OR. Comparisons were made based on a variety of factors, such as demographic data, intra- and postoperative metrics, pain control, patient contentment, and quality of life indicators. ResultsIn the analysis, there were no statistically significant differences in demographic or clinical characteristics between the LR (n=35) and OR (n=62) groups (p > 0.05). Conversely, the rates of incisional hernia and surgical site infection were significantly greater in the OR group (p < 0.05). Moreover, the LR exhibited benefits such as a shorter length of hospital stay (p < 0.05), more rapid resumption of a normal diet, and fewer surgical site infections—factors that contributed to a lower rate of overall postoperative complications. According to the quality of life questionnaire, the LR group exhibited significantly greater scores for physical function, role, pain, and general health by the 30th postoperative day (p=0.003, p<0.001, p=0.006 and p=0.001, respectively), and by the 1-year follow-up, the LR group showed substantial improvements in physical function, physical role, emotional role, pain and general health (p=0.047, p=0.004, p=0.039, p=0.001, p=0.021, respectively), indicating its effectiveness in patient recovery and quality of life enhancement postsurgery. ConclusionThis study showed that LR could provide certain benefits in managing PPUs, such as reduced lengths of hospital stay and lower incidences of surgical site infections. Although LR reported promising directions in patient satisfaction and quality of life indicators, the limited duration of postoperative monitoring necessitates caution in broadly applying these results.

Approaches for the treatment of perforated peptic ulcers: a network meta-analysis of randomised controlled trials – study protocol

IntroductionPerforated peptic ulcers are a life-threatening complication associated with high morbidity and mortality. Several treatment approaches are available. The aim of this network meta-analysis (NMA) is to compare surgical and...

Perforated Peptic Ulcer-Current Management: A Narrative Review

Perforated peptic ulcer is a complication of peptic ulcer disease with its incidence being stable despite the introduction of proton pump inhibitors. This condition is seen in older patients with comorbidities and early diagnosis improves the mortality of this condition. The treatment of perforated peptic ulcer is performed by closure of the perforated peptic ulcer, and this procedure can be performed by open or laparoscopic surgery. The current trend over the last few years has been the use of laparoscopic surgery in the management of perforated peptic ulcer and we have conducted this narrative review article to investigate the current trend in management of this condition.

Modified Graham's Patch Repair Versus Graham's Patch Repair for Treatment of Perforated Peptic Ulcer in Terms of Postoperative Morbidity / Mortality

Objective: To compare the surgical procedures; graham’s patch repair and modified graham’s patch repair for the treatment of perforated peptic ulcer in terms of their post-operative morbidity and mortality.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and duration of study: Combined Military Hospital Rawalpindi, from May 2020 to Apr 2021.&#x0D; Methodology: We conducted the study on 60 subjects divided into groups of two, (Group A and Group B) selected via convenience sampling. Group A underwent Graham’s repair and Group B underwent modified Graham’s repair. The morbidity and mortality of both the groups was compared statistically with data analysis done using SPSS-23.&#x0D; Results: The average operating time and hospital stay was 84.93 ± 7.06 minutes and 7.3 ± 1.63 days for group A and 96.9 ± 9.67 minutes and 7.56 ± 2.27 days for group B, respectively. For both groups, there was no significant association to any complications (p&gt;0.05).&#x0D; Conclusion: Graham’s repair and modified Graham’s repair are equally effective leaving the decision to the surgeon's preference. We however recommend using Graham’s repair in unstable patients.

Comparative study of postoperative complications after open and laparoscopic surgery of the perforated peptic ulcer: Advantages of the laparoscopic approach

BackgroundDespite the acceptance of the laparoscopic approach for the treatment of perforated peptic ulcers, its definitive implantation is still a matter of discussion. We performed a comparative study between the open and laparoscopic approach focused on postoperative surgical complications. MethodsRetrospective observational study in which patients operated on for perforated peptic ulcus in our center between 2001 and 2017 were analyzed. Only those in whom suture and/or omentoplasty had been performed were selected, either for open or laparoscopic approach. Demographic, clinical, and intraoperative variables, complications, mortality and length of stay were collected. Both groups, open and laparoscopic surgery patients, were compared. ResultsThe final study sample was 250 patients, 190 (76%) men and 60 (24%) women, mean age 54 years (SD ± 16.7). In 129 cases (52%), the surgical approach was open, and in 121 (48%) it was laparoscopic. Grades III-V complications of the Clavien-Dindo Classification occurred in 23 cases (9%). Operative mortality was 1.2% (3 patients). Laparoscopically operated patients had significantly fewer complications (p = 0.001) and shorter hospital stay (p < 0.001). In multivariate analysis, laparoscopic approach (p = 0.025; OR:0.45–95%CI: 0.22–0.91), age (p = 0.003; OR:1.03–95%CI: 1.01–1.06), and Boey score (p = 0.024 – OR:1.71 – CI95%: 1.07–2.72), were independent prognostic factors for postoperative surgical complications. ConclusionLaparoscopic surgery should be considered the first-choice approach for patients with perforated peptic ulcer. It is significantly associated with fewer postoperative complications and a shorter hospital stay than the open approach.

Surgery for Perforated Peptic Ulcer: Is Laparoscopy a New Paradigm?

Introduction Laparoscopic repair of perforated peptic ulcer (PPU) remains controversial mainly due to its safety and applicability in critically ill patients. The aim of this study is to compare the outcomes of laparoscopy versus laparotomy in the treatment of PPU. Methods Single-institutional, retrospective study of all patients submitted to surgical repair of PPU between 2012 and 2019. Results During the study period, 169 patients underwent emergent surgery for PPU. A laparoscopic approach was tried in 60 patients and completely performed in 49 of them (conversion rate 18.3%). The open group was composed of 120 patients (included 11 conversions). Comparing the laparoscopic with the open group, there were significant differences in gender (male/female ratio 7.2/1 versus 2.2/1, respectively; p=0.009) and in the presence of sepsis criteria (12.2% versus 38.3%, respectively; p=0.001), while the Boey score showed no differences between the two groups. The operative time was longer in the laparoscopic group (median 100' versus 80', p=0.01). Laparoscopy was associated with few early postoperative complications (18.4% versus 41.7%, p=0.004), mortality (2.0% versus 14.2%; p=0.02), shorter hospital stay (median 6 versus 7 days, p=0.001), and earlier oral intake (median 3 versus 4 days, p=0.021). Conclusion Laparoscopic repair of PPU may be considered the procedure of choice in patients without sepsis criteria if expertise and resources are available. This kind of approach is associated with a shorter length of hospital stay and earlier oral intake. In patients with sepsis criteria, more data are required to access the safety of laparoscopy in the treatment of PPU.

Conventional omental patch repair versus laproscopic closure of duodenal ulcer: A comparative study in north Indian teaching hospital

Background: Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation Laparotomy has been the standard treatment of perforated peptic ulcers. Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. Aim and Objectives: To evaluate the efficacy of Omental patch repair versus laproscopic closure of duodenal ulcer. Materials & Methods: Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. This is a prospective study of patients with perforated duodenal ulcers who underwent laparoscopic repair or open repair. During the study period 53 cases admitted in our surgery emergency and were studied thoroughly according to the prepared proforma, proportions, chi square test and student ‘T’ tests were used to find out the significance.Results: 53 patients were included in our study.49 patients underwent surgical repair of perforated duodenal ulcer disease (16 laparoscopic repairs and 33 open repairs; mean age - (range, 32-82 years). There was decrease in total operative time in patients who had undergone laparoscopy repair (mean: 67.2 minutes laparoscopic versus 106.8 minutes open), less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (mean time to oral analgesia: 3 days laparoscopic versus 6.78 days open). Wound infection and gaping and burst abdomen were nil in laparoscopic (wound infection 8 cases and burst abdomen 2 cases). There was decrease in recovery without complication in patients who underwent laparoscopic repair (02 complications in lap versus 16 complications in open) and shorter in-patient hospital stay (mean: 4.56 days laparoscopic versus 8.94 days open) and early return to normal activity in patients who underwent laparoscopic repair (mean: 6.44 days laparoscopic vs. 11.48 open). Conclusion: Therefore laparoscopic repair is almost safe surgical option for patients with perforated duodenal ulcer disease and should be considered for all patients, provided that the necessary expertise is available.

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower.

BackgroundPerforated peptic ulcer (PPU) is a fatal complication of peptic ulcer disease, which requires emergency surgery. Laparoscopic repair is the widely accepted and effective method for the treatment of PPU. The aim of this study was to evaluate the safety and efficacy of duet laparoscopic repair of PPU with knotless barbed sutures.MethodsFrom January 2013 to May 2019, 40 patients with PPU underwent laparoscopic primary repair and omentopexy at the Dankook University Hospital. The operative outcomes and complications of patients undergoing surgery using continuous suturing with absorbable knotless barbed sutures (group A, n=15) were compared with those undergoing surgery with conventional interrupted sutures (group B, n=25).ResultsThe mean operative time was significantly shorter in group A than group B (84.4±39.8 vs. 104.2±49.4 min, P<0.001). There were no differences in other operative outcomes or postoperative complications (group A vs. group B, 20.0% vs. 24.0%, respectively; P=0.249) between the two groups. The mean operation time spent for laparoscopic sutures and omentopexy was 22.7 minutes.ConclusionsThe findings of the current study, albeit performed retrospectively at a single institution, suggested that duet laparoscopic repair of PPU with knotless barbed sutures might be considered as an alternative option, especially in hospitals lacking manpower.

Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study

Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers. Clinical and surgical data on 42 patients underwent surgical treatment for perforated peptic ulcer from January 2012 to December 2016 were collected. Laparoscopic repair of the perforation with a three-port technique was made in all cases. The Boey scoring system was used to predict the prognosis. All patients underwent suture-closure of the ulcer, and omental patch through laparoscopy without conversion to open surgery. Duodenal leakages occurred in 3 patients (7.1%), then treated with a conservative approach and resolved on the 10th postoperative day. Two patients (4.7%) had deep space infections in the first week after surgery, therefore subdiaphragmatic and pelvic abscess were drained by ultrasound guidance. Four patients (9.5%) died up to 30-day post-surgery due to progression of multisystem organ failure in absence of leakages or infections. All these patients were American Society of Anesthesiologists Classification >III and Boey Score 3. Our data show that a primary laparoscopic approach in patients with peptic ulcer perforation is associated with postoperative advantages and acceptable rates of morbidity and mortality, essentially related to high Boey Score. Therefore, we suggest that the surgical repair of PPU could be always started laparoscopically.

Laparoscopic repair for perforated peptic ulcer: our experience, a comparison with the open approach and a review of the literature.

Backgrounds: The incidence of perforated peptic ulcers has decreased during the last decades but the optimal treatment for these patients remains controversial. At the same time, a laparoscopic approach to this condition has been adopted by an increased number of surgeons. Therefore, this study wants to evaluate the postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in one Italian center with extensive experience in laparoscopic surgery. Methods: This retrospective study includes 94 patients who were operated for perforated peptic ulcer peritonitis at “St. Orsola Hospital - Emergency Surgery Unit - University of Bologna” from May 2014 to December 2019. The patients’ charts were reviewed for demographics, surgical procedure, complications, and short-term outcomes. Results: The diagnosis was made clinically and confirmed by the presence of gas under diaphragm on abdominal X-ray. All patients underwent primary suture repair with or without omentopexy. Boey score 0 or 1 was found in 66 (70%) patients, Boey 2 or 3 in 28 (30%) patients. The operative time was between 35 and 255 minutes, with a mean of 93 minutes. The overall median hospital stay was 9.5 (1-60) days. Post-operative complications occurred in 19 (20%) patients and 18 (19%) patients died. Conclusions: Perforated peptic ulcer is a severe condition that requires early hospital admission and immediate surgery. Laparoscopy in experienced centers and for selected patients is safe, associated with optimal outcomes and should be the preferred approach.

Laparoscopic repair of peptic ulcer perforation - our experience

Introduction: Perforation is a complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of perforation has been widely used. Aim: To evaluate the role of laparoscopy in peptic ulcer perforation in terms of operation time, post operative complicationsMaterial and Methods: 37 cases of ASA garde I,II,III with non traumatic perforated peptic ulcer on diagnostic laparoscopy were included and were analysed further.Results: Among the 37 cases, average age of presentation was 39 ± 6 years. Males were more than female. Average operation time was around 66 ± 15min. 3 cases were with large perforation and extensive contamination was converted to laparotomy. Patients were discharged on 6 ± 3 days.Conclusions: In hand of good experienced laparoscopic surgeon and in a selected cases laparoscopic approach is an effective method for treatment of perforated peptic ulcer.

Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions.

Background: Peptic ulcer disease (PUD) affects four million people worldwide. Perforated peptic ulcer (PPU) occurs in less than 15% of cases but is associated with significant morbidity and mortality rates. Administration of antibiotics is standard treatment for gastrointestinal perforations, including PPU. Although fungal growth is common in peritoneal fluid cultures from patients with PPU, current data suggest empiric anti-fungal therapy fails to improve outcomes. To examine the role of anti-fungal agents in the treatment of PPU, the Surgical Infection Society hosted an Update Symposium at its 37th Annual Meeting. Here, we provide a synopsis of the symposium's findings and a brief review of prospective and retrospective reports on the subject. Methods: A search of Pubmed/MEDLINE, EMBASE, and the Cochrane Library was performed between January 1, 2000, and November 1, 2018, comparing outcomes of PPU following empiric anti-fungal treatment versus no anti-fungal therapy. We used the search terms "perforated peptic ulcer," "gastroduodenal ulcer," "anti-fungal," and "perforated" or "perforation." Results: There are no randomized clinical trials comparing outcomes specifically for patients with PPU treated with or without empiric anti-fungal therapy. We identified one randomized multi-center trial evaluating outcomes for patients with intra-abdominal perforations, including PPU, that were treated with or without empiric anti-fungal therapy. We identified one single-center prospective series and three additional retrospective studies comparing outcomes for patients with PPU treated with or without empiric anti-fungal therapy. Conclusion: The current evidence reviewed here does not demonstrate efficacy of anti-fungal agents in improving outcomes in patients with PPU. As such, we caution against the routine use of empiric anti-fungal agents in these patients. Further studies should help identify specific subpopulations of patients who might derive benefit from anti-fungal therapy and help define appropriate treatment regimens and durations that minimize the risk of resistance, adverse events, and cost.

Surgical treatment of perforated peptic ulcers complicated by diffuse peritonitis: laparotomy or laparoscopy? (Part 1)

Surgical treatment of perforated peptic ulcers complicated by diffuse peritonitis: laparotomy or laparoscopy? (Part 1)

Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study

BackgroundPerforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain.MethodsData on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score.It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay.Post-operative morbidity and mortality relation with patient’s age, surgical technique and Boey’s score were evaluated.ResultsThe relationship between laparoscopic or open treatment and the Boey’s score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients’ Boey’s score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05).30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey’s score group and in the 10.7% of the high Boey’s score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002).ConclusionsLaparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey’s score. In our series laparoscopy was not used in high risk Boey’s score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.

Laparoscopic Repair for Perforated Peptic Ulcer: A Retrospective Study.

The incidence of patients presenting with perforated peptic ulcers (PPU) has decreased during the last decades. At the same time, a laparoscopic approach to this condition has been adopted by increased number of surgeons. The aim of this study was to evaluate the early postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in eight Romanian surgical centers with extensive experience in laparoscopic surgery. Between 2009 and 2013, 297 patients with perforated peptic ulcer were operated in the eight centers participating in this retrospective study. The patients' charts were reviewed for demographics, surgical procedure, complications and short-term outcomes. Boey score of 0 was found in 122 patients (41.1%), Boey 1 in 169 (56.9%), Boey 3 in 6 (2.0%). For 145 (48.8%) patients, primary suture repair was performed, in 146 (49.2%) primary suture repair with omentopexy. There were 6 (2.0%) conversions to open surgery. The operative time was between 25 and 120min, with a mean of 68min. Two (0.7%) deaths were noted. Mean hospital stay was 5.5days, ranges 3-25days. Postoperative complications included: 7 (2.4%) superficial surgical site infections, 5 (1.6%) cardiovascular, 3 (1.0%) pulmonary, 2 (0.7%) duodenal leakages, 3 (1.0%) deep space infections and 1 (0.3%) upper digestive hemorrhage. This study shows that the laparoscopic approach for PPU is feasible; the procedure is safe, with no increased risk of duodenal fistulae or residual intraperitoneal abscesses. We now consider the laparoscopic approach for PPU as the "gold standard" in patients with Boey score 0 or 1.

Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality.

IntroductionThe mainstay of treatment for perforated peptic ulcer is Omental patch closure. With the advent of laparoscopic surgery, this approach is being used for the treatment of perforated peptic ulcer. The aim of this study was to evaluate the outcome of laparoscopy in Firoozgar general hospital over a period of 18 months. The outcome of the laparoscopic approach and the associated morbidity and mortality, operation time, conversion rate and hospital stay were assessed.MethodsA prospective analysis of 29 consecutive patients (mean age 37.5 years; 23 men) with perforated peptic ulcers and who had undergone laparoscopic surgery was carried over a period of 18 months from March 2014 until September 2015. Pre-operative, intra-operative, and post-operative clinical data were collectively analyzed by SPSS 19 for Windows.ResultsSeventeen patients had a history of cigarette smoking, 11 patients had a history of opium consumption, 19 were chronic NSAID users, 26 had Helicobacter pylori infections, and six had a co-morbid condition. Previous surgical history included laparotomy for pancreatic cancer in two patients, for sigmoid colon cancer in one patient, and for acute appendicitis in four patients. The average operating time for all cases was 47.5 + 20 min. The mean lag time between onset of symptoms and surgery was 20.4 hours. All patients underwent laparoscopic closure of the perforation with Omental patch closure. No morbidity was observed, and none of the patients needed conversion to open surgery. One patient died after 11 months of follow-up due to the progression of underlying pancreatic cancer. The mean postoperative hospital stay was 4.2 days.ConclusionsThe results of the laparoscopic approach for perforated peptic ulcer were promising, with no conversion to open surgery, no morbidity, and mortality.

Outcome of nonsurgical intervention in patients with perforated peptic ulcers

BackgroundAlthough surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. MethodsBetween 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. ResultsThe overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (<IV) American Society of Anesthesiologists class (83.3% vs 0%, P=.015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class (P=.018). ConclusionsA higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.

Surgical treatment of perforated gastroduodenal peptic ulcers: comparison between open and laparoscopic approach

Background: Laparotomy has long been the standard treatment of perforated peptic ulcers. Laparoscopy allows the confirmation of the diagnosis, better magnified visualization during the procedure and the identification of the position, site and size of the ulcer. The aim of this study is to compare the surgical outcomes of patients with perforated gastric or duodenal peptic ulcers treated either open or laparoscopic in our institution. Methods: We retrospectively reviewed records of patients with perforated peptic ulcers who underwent laparoscopic repair or open repair, from January 2013 to May 2016 in our hospital. We analyzed preoperative patient baseline parameters, and intraoperative and postoperative outcomes. Results: Repair of perforated peptic ulcers was performed in 27 patients, using laparoscopic surgery for 14 patients and open surgery for 13 patients. The comparison between the two groups revealed statistically similar results regarding age, gender, BMI and ASA score. Laparoscopic repair was associated with less estimated blood loss (20 vs. 121.5 mL, p=0.025), less duration of nasogastric decompression (1.2 vs. 3.4 days, p=0.000), faster return to diet (2.5 vs. 4 days, p=0.0001) and shorter hospital length of stay (5.5 vs. 7 days, p=0.019). There were no significant differences between the two procedures with regard to operative time (103.9 vs. 101.2 min), use of abdominal drains (71.4% vs. 76.9%) and in-hospital complications (7.1% vs. 15.4%). Conclusions: Laparoscopic repair of gastroduodenal perforations provides a safe and feasible alternative treatment to perforated gastroduodenal peptic ulcers. Results in our study are in concordance with results published globally.

Observational study of laparoscopic closure of peptic ulcer perforation in rural population

Background: Peptic ulcer perforation is one of the common surgical emergencies which need immediate surgical intervention. For many years, the routine upper laparotomy still seems to be the routine treatment of perforated peptic ulcer. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery. Objective of the study was to assess the efficacy of laparoscopic approach in perforated peptic ulcer repair. Methods: The present study is based on the analysis of 30 cases of peptic ulcer perforation admitted to our hospital between 2013 and 2015. Post-operative mobilization of every patient was done after 6 hours and H 2 receptor antagonist or proton pump inhibitor was given with fluid, antibiotics and nasogastric suction. Post-operation analgesics (IV tramadol ± IM diclofenac SOS) were given according to visual analogue score (VAS). Results: 22 (73.33%) patients were having duodenal ulcer perforation and 8 (26.67%) were having gastric ulcer perforation. Postoperatively out of 30 patients, 18 patients were presented with VAS 4. The most common complication was trocar site infection seen in 2 patients (6.6%). 3 patients (10%) needed to covert laparoscopic procedure into open procedure due to large size of perforation (>10 mm). The hospital stay varied from 4-16 days. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and reliable technique. It gives the patient all the advantages of laparoscopic surgery with accepted post-operative morbidity and mortality rates. However, laparoscopic closure of the perforation is technically demanding. It should be considered as a good choice in the presence of reasonable laparoscopic skills and experience. It had less postoperative pain and reduced analgesic usages, shorter postoperative hospital stay and early return to oral feeding and normal daily activities.

Postoperative Morbidity and Mortality of Perforated Peptic Ulcer: Retrospective Cohort Study of Risk Factors among Black Africans in Côte d'Ivoire.

Introduction. Surgical treatment of perforated peptic ulcer (PPU) is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male) operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5%) experienced complications and 31 (19.3%) died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9–8.0) per 100 person-days and 3.0 (95% CI: 1.9–4.0) per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P = 0.03), tachycardia (pulse rate > 100/minutes) (HR = 2.4, P = 0.02), purulent intra-abdominal fluid collection (HR = 2.1, P = 0.04), hyponatremia (median value ≤ 134 mEq/L) (HR = 2.3, P = 0.01), delayed time of hospital admission > 72 hours (HR = 2.6, P < 0.0001), and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P < 0.0001). Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU.