Current Status of Indications for Surgery in Peptic Ulcer Disease

Abstract

Abstract. The eradication of Helicobacter pylori in patients with peptic ulcer disease has greatly diminished the need for antiulcer surgery. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out. If the required expertise is available, it can be undertaken laparoscopically. The advent of endoscopic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic ulcer disease. Once again, however, when such therapy fails surgery is still indicated. Even with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nonoperative management of perforation is indicated in fit patients if the diagnosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extremely ill either because of comorbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is established to be unsealed, particularly after a trial of conservative management, and in all patients who are otherwise fit.

Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery

“…Finally, controversy surrounds whether conservative treatment of perforated gastroduodenal ulcer is justified in selected patients [8,29,30]. According to the review of Zittel and colleagues [2], conservative treatment is possible in 60% of cases, while 30% of patients need emergency surgery.…”

Laparoscopic repair of perforated peptic ulcer: a meta-analysis

“…Although laparoscopic repair combines the principles of open repair with the advantages of minimal access surgery, it has not been widely accepted by general surgeons. Concerns including a longer operation time as well as equivocal postoperative benefits and cost effectiveness have meant the slow adoption of this approach [16].…”

Comparative Evaluation of Graham’s Omentopexy Versus Modified Graham’s Omentopexy in Perforated Duodenal Ulcers

“…8 In this study 84 patients of perforated duodenal ulcer were included out of them 76 (90.5%} were males and 8 (9.5%) were females (male: female 9.5 :1) similar to other studies by Nishikant Gujar et al, male were (86%), female (14%) where the M: F ratio ranged from 6.15 : 1 to 9 :1.…”