Current management of perforated peptic ulcer

Perforated peptic ulcer disease: mid-term outcome among Iranian population

“…It is clear that many surgeons advocate performing definitive ulcer-curing surgery along with simple closure to prevent recurrence. However, due to the success of medical management and the subsequent decreasing role of elective surgical management in peptic ulcer disease, fewer surgeons are acquiring sufficient experience and expertise in performing definitive procedures such as highly selective vagotomy (5). We believe that combined medical therapy for Helicobacter pylori and simple closure of the perforation would be more desirable than undergoing a definitive operation, given at least a similar rate of ulcer recurrence.…”

“…Some surgeons believe that many patients can be successfully managed medically with no operation and that better outcomes can be achieved. Moreover, several studies have indicated significant side effects, including diarrhea, dumping, vomiting, and weight loss due to ulcer operations (5,6). Some others have suggested surgical management, especially simple closure (7).…”

Successful closure of chronic recurrent Enterocutaneous fistula with a concurrent over‐the‐scope closure and a stent placement

“…The management of perforated PUD presents a challenge for clinicians. Traditionally, surgical approach ranging from simple closure of the perforation to definitive ulcer‐curative procedure, usually vagotomy with antrectomy, was the primary intervention . This, however, entails an invasive surgical procedure, which carries increased morbidity and mortality compared with nonoperative approach .…”

“…Traditionally, surgical approach ranging from simple closure of the perforation to definitive ulcer‐curative procedure, usually vagotomy with antrectomy, was the primary intervention . This, however, entails an invasive surgical procedure, which carries increased morbidity and mortality compared with nonoperative approach . Those undergoing an ulcer‐curative procedure are associated with increased operative mortality of 1%‐2% and postoperative sequelae such as anastomotic leak, gastric stasis, dumping syndrome, diarrhea, and bilious vomiting .…”

“…8,9 Those undergoing an ulcer-curative procedure are associated with increased operative mortality of 1%-2% and postoperative sequelae such as anastomotic leak, gastric stasis, dumping syndrome, diarrhea, and bilious vomiting. 8,10,11 The nonoperative approach with intravenous proton-pump (PPI) inhibitor or intravenous H2 antagonist is considered in selective patients without pneumoperitoneum on initial presentation. 8 The emerging endoscopic technologies are allowing gastroenterologists to utilize more conservative endoscopic approaches.…”