Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data

Rickard, Jennifer

doi:10.1007/s11605-015-3025-7

Cited by 25 publications

(26 citation statements)

References 27 publications

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“…2,3 Other investigators have also noted increased risk of death with an increasing interval between perforation and initiation of treatment. [20][21][22][23]38 The same has not been observed in this study. The delay in presentation did not have a significant impact on mortality.…”

Section: Discussionsupporting

confidence: 61%

“…Rickard et al in a review of surgery for complications of peptic ulcer reported a 60% vagotomy rate from subsaharan Africa. 23 Seow et al have found a gastric resection rate of 1 in 10 in a series of 599 patients of PPU operated over a period of 8 years. 29 Agaba reported a 2% definite anti-ulcer procedure in a decade long period with 98% patch closure.…”

Section: Discussionmentioning

confidence: 97%

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The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 97%

The outcome of surgery for perforated peptic ulcer in modern times

Vats¹,

Rehmani²,

Agrawal³

2018

Int Surg J

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“…Patients, who underwent surgery for PUD in Sub-Saharan Africa, indicated that 86% suffered from duodenal ulcers while the rest 14% had gastric ulcer. e major complications like perforation (35%), bleeding (7%), obstruction (30%), and chronic case (28%) were indicated for surgery, and the overall fatality rate was found to be 5.7% [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Antiulcer Activity of 80% Methanol Extract and Solvent Fractions of the Root of Croton macrostachyus Hocsht: Ex Del. (Euphorbiaceae) in Rodents

Norahun¹,

Atnafie

Atta

2020

Evidence-Based Complementary and Alternative Medicine

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Background. Peptic ulcer disease causes significant mortality and morbidity. Plant kingdom provides a useful source for the development of new antiulcer agents. Croton macrostachyus is traditionally used to treat peptic ulcer in Ethiopia. This study aimed to evaluate the antiulcer activity of C. macrostachyus root extracts in rodents using different models. Methods. The crude extract was obtained by cold maceration in 80% methanol and fractionated with chloroform, ethyl acetate, and distilled water. The antiulcer activity was evaluated using pylorus ligation-induced ulcer model in Sprague Dawley rats and acidified ethanol-induced ulcer model in Swiss albino mice. The test groups received three doses (100, 200, and 400 mg/kg) of the crude extract and fractions for 7 days before induction of ulcer. Positive controls received omeprazole 30 mg/kg for the pylorus ligation-induced ulcer model and sucralfate 100 mg/kg for the acidified ethanol-induced ulcer model. Negative controls received vehicle (2% tween 80). Results. The crude hydromethanolic extract of C. macrostachyus showed significant (p<0.05) antiulcer activity on both pyloric ligation and HCl/ethanol-induced ulcer in rats and mice. It has antisecretary effect (p<0.001) as well. All three administered doses of chloroform fraction (p<0.05) and only higher doses of ethyl acetate fraction (p<0.05) possessed significant antiulcer activity. In contrast, the aqueous fraction did not have significant antiulcer effect at all tested doses. Conclusion. The present study demonstrated that the crude extract, chloroform, and ethyl acetate fractions possessed significant dose-dependent antiulcer activity.

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“…The ideal treatment option for patients with peptic ulcer perforation is primary suturation and irrigation of peritoneal cavity in an emergency manner. [3] However, it is controversial that whether laparoscopic approach or conventional open surgery should to be choose. Although laparoscopic surgery has great advantages such as short hospital stay, less level of pain, better cosmetic results, it requires a certain learning curve and experiences to gain afformentioned advantages.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] Peptic ulcer perforation is a condition that requires immediate surgical intervention and open or laparoscopic surgery may be preferred. [1,3] As is known, most elective open surgeries have more intraoperative blood loss than laparoscopic surgery, more postoperative hospital stay and more postoperative pain. [4][5][6] Studies have shown that emergency laparotomy is associated with 5% mortality, 20% morbidity and 3% long term bowel obstruction.…”

Section: Introductionmentioning

confidence: 99%

Management of Peptic Ulcer Perforations; Comparison of Open and Laparoscopic Procedures.

Birol¹

2019

Laparosc Endosc Surg Sci

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Introduction: Peptic ulcer perforation requires urgent surgical intervention, but there is no consensus on a preference for open or laparoscopic surgery. The aim of this study was to compare the results of laparoscopic and open methods of surgery for patients with a peptic ulcer perforation. Materials and Methods: The data of 52 patients who underwent surgery for peptic ulcer perforation at 4 hospitals were investigated retrospectively. The patients were divided into 2 groups according to the surgical technique applied: open surgery or laparoscopic. Both techniques used an omental patch to repair the perforation. Patient age, gender, preoperative blood white blood cell count, blood amylase level, duration of symptoms before admission to the hospital, length of operation, number of drains, quantity of intra-abdominal free fluid observed during the operation, quantity of fluid used for irrigation, patient abdominal operation history, and complications were noted and analyzed. Results: Thirty-seven of the patients underwent open surgery and 15 underwent laparoscopic surgery (mean age: 37.73±16.85 years; female/male 3/49). There was no significant difference in the parameters between the groups. No mortality was observed in any of the patients. Wound infection developed in 2 patients who were operated on using the open technique. Only 1 case of laparoscopic surgery (6.66%) was converted to open surgery. Conclusion: Laparoscopic repair of a peptic ulcer perforation demonstrated results that were similar to open surgery and helps to reduce complications such as wound infection. It may be especially valuable in earlyonset cases and younger patients.

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Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data

Abstract: Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.

Cited by 25 publications

References 27 publications

The outcome of surgery for perforated peptic ulcer in modern times

The outcome of surgery for perforated peptic ulcer in modern times

Evaluation of Antiulcer Activity of 80% Methanol Extract and Solvent Fractions of the Root of Croton macrostachyus Hocsht: Ex Del. (Euphorbiaceae) in Rodents

Management of Peptic Ulcer Perforations; Comparison of Open and Laparoscopic Procedures.

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