Perforated Peptic Ulcer: Long‐term Results after Simple Closure in the Elderly

Abstract

The relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined. To evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital. During 1983-1992 a total of 151 patients were admitted with perforated peptic ulcer; 92 were elderly (i.e., 70 years or older), 63 of whom were operated with simple closure. Mortality at 30 days was 27% (17/63) and the total in-hospital mortality 30% (19/63). After a mean follow-up of 79 months, 14 of the 44 survivors are still alive. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. Because the rate of serious recurrences is low (14%, 6/44), it is concluded that simple closure is an adequate surgical treatment for peptic ulcer perforation in the elderly.

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

“…It should be also noted that the mean age of patients from this series was considerably lower than that from patients included in different studies. Thus, such differences might account for the markedly lower overall mortality rate (4.0 %), as compared to other series [6][7][8][11][12][13][14][15][16][17][18][19][20] . In accord with others [19,23] , we could not find that male sex was associated with a greater mortality rate.…”

“…Perforation has been found to be a major complication of PUD with a mortality rate ranging from 6 % to 31 % [6][7][8][11][12][13][14][15][16][17][18][19][20] . Age of patients with PPU has been gradually increasing over the last years [21][22][23] .…”

“…Apparently, these findings were at variance with those from two other studies [13,24] reporting a higher mortality rate in gastric peptic ulcer than in duodenal peptic ulcer and in acute peptic ulcer than in chronic peptic ulcer. Such apparent discrepancies might be explained by the characteristics of patients included in the study, and/or by different age or different surgical procedures [16,18] . This study confirmed the previous observations [5,8,15,[25][26][27][28] that shock on admission and delayed operation were both associated with a greater mortality rate.…”

“…In some series definitive surgery had lower rates of recurrence and mortality than non definitive surgery [16,18,19,29,30] . Otherwise, non-definitive surgery was more frequently performed in patients admitted with more risk factors than definitive surgery, and this might explain the higher mortality rate of such studies.…”

The Long-Term Results Comparative Analysis of Simple Closure the Ruptured Peptic Ulcer and the Partial Gastrectomy

“…Отдаленные результаты становятся сопоставимыми с результатами первично-радикальных оперативных вмешательств, таких как резек-ция желудка [9,11]. Основным условием безрецидивного отдаленного периода ав-торы считают постоянное наблюдение и лечение у гастроэнтеролога [6,7,12].…”