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PubMedDate not supplied

Surgery for perforated peptic ulcer in the elderly. Evaluation of factors influencing prognosis.

BACKGROUND/AIMS: The frequency of perforated peptic ulcer is decreasing among the overall population but it is becoming more frequent among old people. The higher mortality rate in the old population, justifies the search of prognostic factors specific for the elderly. Aim of this study is to analyze and define factors influencing surgical prognosis in patients older than 70 years who were operated for perforated peptic ulcer. METHODOLOGY: A retrospective analysis of 37 patients was performed: age, sex, ASA status, site of perforation, diameter of perforation, duration of symptoms, MPI score, surgical treatment (suture vs. resection) were studied. All patients were grouped as deceased and not deceased after surgery: a statistical univariate analysis was performed regarding the whole series and regarding the patients 70 years and older. RESULTS: Postoperative mortality rate was 18.92% in the whole series but 41.8% among the elderly. In the whole series age, ASA status, diameter of perforation, duration of symptoms, and MPI score were significantly related to postoperative death. In the patients 70 years and older the duration of symptoms, the size of perforation and the MPI score were significantly related to postoperative death. CONCLUSIONS: The duration of symptoms is a known factor that influences the prognosis after surgery for perforated peptic ulcer. This factor is still the most important in the elderly being responsible of the high mortality rate. The delay in treatment is due to a delayed hospitalization of old patients, who show a low reactivity to the disease.

Adult↗
PubMed1999

Open vs laparoscopic repair of perforated peptic ulcer.

BACKGROUND: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer. METHODS: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996. RESULTS: The OR and LR patients were comparable for age, weight, American Society of Anesthesiologists (ASA) grade, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Boey score, ulcer site, Mannheim Peritonitis Index (MPI), delay of surgery, Helicobacter pylori infection, nonsteroidal antiinflammatory drug (NSAID) intake, and previous abdominal surgery. More LR than OR patients were operated on by staff surgeons (chi2 = 46.9, 1 d.f., p << 0.01). Mortality (OR: 12, LR: two), morbidity (OR: eight, LR: two), estimated blood loss (OR: 120 ml, LR: 95 ml), solid food intake resumption (OR: 5 days, LR 4 days), NSAID consumption (OR: 2,225 mg, LR: 1,815 mg), delayed gastric emptying (OR: two, OR: one), and hospital stay (OR: 9 days, LR: 7 days) were not significantly different for the two groups. Four LR patients (23. 5%) were converted to OR due to failure to progress (n = 3) or posterior perforation (n = 1). Operating time was shorter in OR patients (65 min versus 92 min, p << 0.01). LR patients had reduced opioid consumption (256 mg versus 134 mg, p << 0.01). One LR and 16 OR patients were lost to follow-up. Median follow-up was 14 months (range, 2-55) and 18 months (range, 1-62) in OR and LR patients, respectively. There were more LR than OR patients with Visick score I (p = 0.002) and more OR than LR patients with Visick score II (p = 0.0001). Scores III and IV did not differ significantly. CONCLUSION: The laparoscopic repair of perforated peptic ulcer does not yield any additional benefits over the open repair.

Adult↗
PubMed1993

Should the degree of peritoneal soiling and duration of perforation influence surgical strategy in perforated peptic ulcer?

A prospective study was undertaken in patients with perforated peptic ulcer to ascertain which organisms were encountered and to assess what role the duration of peritoneal soiling plays in the flora encountered and whether the degree of peritoneal soiling, as judged by the surgeon, correlates with bacterial contamination. After assessing the degree of soiling, pus swabs were taken and aerobic and anaerobic cultures and antibiotic sensitivity tests were performed. The most common organisms encountered were Gram-positive cocci (47%) followed by Gram-negative organisms (33%). There was no statistically significant increased bacterial growth time elapsed up to 48 hours. Severe peritoneal soiling, as judged by the surgeon, did not imply greater contamination.

Adolescent↗
PubMed2004

Evaluation of risk factors for mortality in perforated peptic ulcer in Ankara Numune Teaching Hospital, Ankara, Turkey.

OBJECTIVE: To assess the risk factor that influence mortality from perforated peptic ulcer. DESIGN: Retrospective study. SETTING: Ankara Numune Teaching and Research Hospital, Ankara, Turkey. SUBJECTS: A total of 342 patients with perforated peptic ulcer disease were identified from April 1997 to January 2004. Data for the patients were extracted from the hospital records, operative notes and clinic charts. MAIN OUTCOME MEASURES: Age, sex, coexisting medical illness, use of non-steroidal anti-inflammatory drugs (NSAID) or steroids, preoperative shock, delay in treatment location of ulcer size, type of operation time, albumin concentration postoperative complications, postoperative hospitals stay and mortality results for all patients were obtained. RESULTS: Patients were aged from 17 to 80 years (mean 63 years, median 68 years) there were 210 males and 132 females. The mortality rate was 8.8% (30/342), and 62 patients had postoperative complications. Multivariate analysis showed that co-existing medical illness, preoperative shock, delay in treatment and low albumin concentrations were independent risk factors that significantly contributed to mortality. CONCLUSION: This study confirms co-existing medical illness, preoperative shock, delay in treatment and low albumin concentration as significant risk factors that increase mortality in patients with perforated peptic ulcers. These factors could serve as a guide to opine the risk and to improve the outcome in patients with perforated peptic ulcer. Mortality could be reduced by preventing delay in diagnosis and treatment for any co-existing medical illness and providing appropriate nutrition support.

Adolescent↗
PubMedDate not supplied

Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers.

BACKGROUND/AIMS: The purpose of this study was to determine the value of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers. METHOLOGY: Eighty-four patients with perforated peptic ulcers receiving both upright chest radiography and ultrasonography before laparotomy. The sensitivity of each modality in demonstrating free air was correlated. RESULTS: Among the 84 patients receiving both examinations, free air was demonstrated in only 39 (46%) upright chest radiographs and 46 (55%) ultrasonographs, the direct sign could be demonstrated in 57 (68%) patients by combined radiography and ultrasonography. Besides, the indirect sign of ascites could be demonstrated in 26 (31%) ultrasonographs. CONCLUSIONS: Ultrasonography is more sensitive than upright chest radiography to demonstrate free air of perforated peptic ulcers, and it should be considered in those patients of suspected perforated peptic ulcers with negative upright chest radiography. Combined methods of upright chest radiography and ultrasonography can increase the overall sensitivity in demonstrating free air.

Adolescent↗
PubMed1994

[Laparoscopic and conventional suture of perforated peptic ulcers--a comparison].

After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 13 consecutive patients with laparoscopic closure were compared to 8 previous patients with conventional surgery. The endpoints adverse advents (complications), pain intensity, fever, leucocytosis and hospital stay showed no clinically relevant differences. Consumption of analgesics was lower in the laparoscopy group. Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by a randomized controlled trial.

Adult↗
PubMed2003

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

AIM: To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS: One hundred and forty-nine consecutive patients (M:F ratio=110:39, mean age 52 yrs, range 16-95) with peptic ulcer disease were investigated for clinical history (including age, sex, previous history of peptic ulcer, associated diseases, delayed abdominal surgery, ulcer site, operation type, shock on admission, postoperative general complications, and intra-abdominal and/or wound infections), serum analyses and radiological findings. RESULTS: The overall mortality rate was 4.0%. Among all factors, an age above 65 years, one or more associated diseases, delayed abdominal surgery, shock on admission, postoperative abdominal complications and/or wound infections, were significantly associated (chi2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION: Factors such as concomitant diseases, shock on admission, delayed surgery, and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.

Academic Medical Centers↗
PubMed1984

Pneumogastrography in the diagnosis of perforated peptic ulcer.

During the 5 year period ending December 1982, 57 patients underwent operation for perforated peptic ulcer. Pneumogastrography was utilized in nine patients who were suspected of having perforation but who had equivocal physical findings and normal findings on initial roentgenographs. All patients with initial pneumoperitoneum or pneumoperitoneum after gastric insufflation were operated on within 6 hours of admission for a combined mortality rate of 9.7 percent. Patients without free air, initially equivocal examinations, and in whom pneumogastrography was omitted, experienced an average delay of 27 hours. The overall mortality rate in these patients was 28 percent. We conclude that pneumogastrography enhances the sensitivity of plain diagnostic roentgenography in confirming the diagnosis of perforated gastric or duodenal ulcer. Gastric insufflation is recommended whenever perforated peptic ulcer is considered in the differential diagnosis and initial films are inconclusive.

Adolescent↗
PubMed2000

[Perforated peptic ulcers].

Two hundred forty-eight patients were operated for perforated peptic ulcer between 1983 and 1998. Of the patients 112 (45.1%) had chronic, 34 (13.7%) had acute ulcer history and 102 (41.2%) had no ulcer history. Of the patients 228 (92.0%) had duodenal, 9 (3.6%) had juxtapyloric, 6 (2.4%) had marginal, and 5 (2.0%) had antral ulcer. Forty two patients (16.9%) admitted within 12 hours and 206 patients (83.1%) between 12 hours and six days after perforation. Simple closure and omental patch was performed in 32 patients (12.9%) who had severe concomitant illness and 126 (50.8%) intraabdominal sepsis, truncal vagotomy + pyloroplasty in 32 (12.9%), simple closure + omental patch + truncal vagotomy + gastroenterostomy in 34 (13.7%), simple closure + omental patch + parietal cell vagotomy in 21 (8.5%), truncal vagotomy + antrectomy in 3 (1.2%). Patients who didn't have definitive procedure received H2 receptor blockers or proton pomp inhibitors. One hundred ninety-three patients (77.8%) underwent endoscopic control. Two of 53 patients with definitive procedure (3.8%) and 34 of 140 patients (24.3%) with simple closure had recurrence. Two patients in simple closure group underwent parietal cell vagotomy, the others received medical treatment. The recurrence rate was significantly higher in simple closure group (p < 0.01).

Acute Disease↗
PubMed1977

Perforated peptic ulcer: an analysis of 246 cases.

An analysis of 246 cases of perforated peptic ulcer, treated at the Royal Newcastle Hospital from 1964 to 1974, is presented. The incidence has fallen considerably over that period. The rising proportion of women has reached a plateau. A perforated peptic ulcer in an Australian women is still just as likely to be located in the stomach as in the duodenum. In men, however, 84% of perforations are pyloroduodenal. A perforated gastric ulcer is closely associated with the use of salicylate preparations. The mortality rate has remained steady at 15% over the last 30 years. It is significantly higher in women. There is a highly significant relationship between the mortality and (a) the duration of perforation; and (b) the size of the perforation, particularly if it is located in the stomach.

Adult↗
PubMedDate not supplied

Laparoscopic and open approach in perforated peptic ulcer.

BACKGROUND/AIMS: To improve the perioperative course and quality of life of the patients with perforated peptic ulcer, we investigated the conversion risk factors in laparoscopic simple closure and omental patch repair for perforated peptic ulcer. METHODOLOGY: A total of 71 patients with a mean age of 46 years (rage, 17-81 years) was examined, and their clinical data was recorded and analyzed. RESULTS: The postoperative durations of nasogastric tube insertion, ileus, analgesic requirement, resuming diet, and hospital stay were shorter in the patients with laparoscopic simple closure than in those with open simple closure and omental patch repair. Univariate regression analysis revealed that the age, American Society of Anesthesiologist classification, presence of concomitant disease, and length of free air or fluid collection shown in abdominal computerized tomography significantly correlated with the conversion of laparoscopic simple closure and omental patch repair to open simple closure and omental patch repair. CONCLUSIONS: These conversion factors are useful to achieve appropriate surgical treatments for perforated peptic ulcer.

Adult↗