Perforated Peptic Ulcer Disease: A Review of History and Treatment

Bertleff, M. J. O. E.; Lange, Johan F.

doi:10.1159/000264653

Cited by 253 publications

(255 citation statements)

References 169 publications

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“…Perforation occurs in 2%-10% of PU patients and accounts for more than 70% of deaths associated with PU disease (21,22). PU perforation used to be a disorder mainly of younger patients (predominantly males), whereas the current peak age is 40-60 years (23). Our results correlate with this report.…”

Section: Original Articlesupporting

confidence: 87%

Peptic ulcer complications requiring surgery: What has changed in the last 50 years in Turkey

Güzel

Kahramanca²,

Seker³

et al. 2014

Turk J Gastroenterol

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Background/Aims: The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. Materials and Methods: This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. Results: In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). Conclusion: From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.

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Section: Original Articlesupporting

confidence: 87%

Peptic ulcer complications requiring surgery: What has changed in the last 50 years in Turkey

Güzel

Kahramanca²,

Seker³

et al. 2014

Turk J Gastroenterol

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“…Hence, we came up with a scoring system that incorporated these points which could strengthen the existing Boey's score that could still be used as an effective tool in a peripheral center to predict mortality cost effectively. [14] The present series reveals that the mortality is less when resuscitation is carried out in the PO interval. A high mortality was observed in nonresuscitated patients in both referred and direct groups thus signifying the importance of resuscitation in the PO interval.…”

Section: Discussionmentioning

confidence: 52%

Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

Prabhu¹,

Prasadi²,

Gore³

2015

Int J Med Public Health

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Objective: An attempt to analyze why in spite of prolonged perforation-operation (PO) interval mortality in patients of perforated duodenal ulcers is less in some patients and whether resuscitative measures in PO interval infl uences mortality particularly in a rural hospital. Materials and Methods: A retrospective analysis of 81 cases of perforated duodenal ulcers presenting in the surgical clinic in a rural medical college which is also a tertiary referral center. Resuscitation, if received in the PO interval was recorded, and a corrected score was calculated and compared statistically with the conventional Boey score. Results were analyzed using Microsoft Excel and SPSS 22 software. Results: Sample size of 81 patients had 70 referred and 11 direct patients. Six out of 11 direct patients succumbed (P = 0.545) and six out of 70 patients succumbed in the referred group (P = 0.086) suggesting that patients presenting directly to the tertiary center with a prolonged PO interval without any intervening resuscitation the prognosis is poor whereas a delayed PO with intervening medical intervention has a better prognosis. The PO interval was 23-168 h with a mean of 42.12 (standard deviation 26.86). Conclusion: In a rural referral center, the resuscitation done in the PO interval is signifi cant as the prognosis is better in the group of patients resuscitated in the PO interval even if there is a delay in the surgical intervention whereas the mortality is higher in those group of patients who have come directly to the center and subjected to surgical procedure, but without any resuscitation in the PO interval. Hence, resuscitation in PO interval is paramount for a better prognosis.

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“…The incidence of PUD has been 1.5% -3% (2). Although 10% -20% of the patients with history of PUD will complicate, out of this 2% -14% patient will have perforation peritonitis (3)(4)(5). Patients with PUD perforation carries high risk of mortality and morbidity (6).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Repair of Duodenal Perforation by “Hanging Method” -Technique and Benefits

Babu

Raikhy

Ghosh

et al. 2017

J Minim Invasive Surg Sci

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Background: Laparoscopic repair of duodenal perforation using the omental patch is one of the traditional techniques, which gives better postoperative recovery in patients with little chances of abdominal wound infection. This article is about the technique used for the laparoscopic repair of the duodenal perforation by Grahams patch with a twist in the conventional technique. Methods: In Hanging method of duodenal repair first, an intra-corporeal suture is taken at the upper margin of perforation and both end of the thread is taken out of anterior abdominal wall and duodenum is pulled up. Now under vision the next two parallel sutures are passed, thus avoiding the posterior duodenal wall incorporation. Finally omentum flap is used for the closure of perforation. Conclusions:The laparoscopic closure of the duodenal perforation by "Hanging Method" is an appropriate Laparoscopic technique, as "hanging" the anterior wall of duodenum gives us better vision of the posterior wall of duodenum, while taking the suture through anterior duodenal wall. Further since the gall bladder is retracted there is an easy available working space for intracorporeal suturing.

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Perforated Peptic Ulcer Disease: A Review of History and Treatment

Cited by 253 publications

References 169 publications

Peptic ulcer complications requiring surgery: What has changed in the last 50 years in Turkey

Peptic ulcer complications requiring surgery: What has changed in the last 50 years in Turkey

Does resuscitation in perforation-operation interval modify the mortality in duodenal perforations?

Laparoscopic Repair of Duodenal Perforation by “Hanging Method” -Technique and Benefits

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