Surgery for Peptic Ulcer Today

Abstract

Background: During the past 20 years medical therapy of peptic ulcer disease (PUD) has dramatically improved. Simultaneously there has been a significant improvement in living and dietary habits. Quite presumably, all these significant events are reflected in the incidence and results of surgery for peptic ulcerations. Aim: To study the incidence, methods and mortality of surgery for PUD. Methods: The nationwide data between 1987 and 1999 were obtained from the National Research and Development Centre for Welfare and Health. In the analysis the codes of the ICD 9–10 were used. Results: The annual incidence of elective surgery for PUD decreased from 15.7 to 1.7 operations (per 10⁵ inhabitants, mean of 2 consecutive years) between 1987 and 1999 (p < 0.05). Simultaneously, the annual incidence of emergency surgery increased from 5.2 to 7.0 operations (per 10⁵ inhabitants, p < 0.05). In 1987, local procedures (duodeno-/gastrorrhaphy or duodeno-/gastrostomy and suture) were applied in 25% of operations for PUD, whereas in 1999 they were 90% of the methods in PUD surgery. The overall annual mortality from PUD surgery remained 8% between 1987 and 1999. Conclusions: Elective ulcer surgery has virtually disappeared and parietal cell vagotomy has become history, whereas the incidence of emergency surgery increased significantly between 1987 and 2000, with the exception of the most recent years. Local procedures are overwhelmingly applied in emergency surgery and more extensive surgery is unnecessary. Nevertheless, the overall surgical mortality remained 8% between 1987 and 1999.

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

“…In Bin-Taleb's (10) study, postoperative complication rate was 41% and overall postoperative mortality was 3.9%. According to the similar previous studies, early mortality rate varied widely, ranging between 3.9% and 30% (10,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The mortality rate following surgery in elderly patients with perforated peptic ulcer is higher than in youn- (13), and it has been reported between 12% and 47% (13,17).…”

Trends and Outcomes of Hospitalizations for Peptic Ulcer Disease in the United States, 1993 to 2006

“…The improved mortality likely reflected the paradigm shift in the inpatient treatment of PUD, including early use of therapeutic endoscopy to control bleeding (which accounted for over 70% of admissions), 6,11,12 benefits of intravenous proton pump inhibitors before and after endoscopic treatment, 5-7 benefits of endoscopic retreatment (rather than surgery) for recurrent bleeding, 10,12 and decreased definitive operation for PUD in the emergent or urgent setting. 13,15,16,18,20,21 While the use of surgical oversewing of ulcers remained stable, the use of definitive ulcer surgery (vagotomy or gastrectomy) decreased by more than 50% between 1993 and 2006. This finding is similar to that of a recent survey in the United Kingdom showing that most surgeons currently do not add vagotomy to the surgical treatment of perforated or bleeding peptic ulcer.…”

“…1,2 Advances include the introductions of H2 receptor antagonists, 1-3 proton pump inhibitors, 4 -7 Helicobacter pylori eradication therapies, 8,9 and evolving endoscopic approaches to treat bleeding ulcer. 10 -12 While there has clearly been an associated and dramatic decrease in the volume of elective peptic ulcer surgery, [12][13][14][15][16][17][18][19] the influences of these therapeutic advances on hospitalization and operations for peptic ulcer complications is unclear, 16,18,19 especially considering the rising proportion of emergency or urgent operations. 15,16,18,20,21 In this study, we examined the time trends of hospitalizations for PUD in the United States (US) during 1993 to 2006, focusing on the changes in ulcer site, complications, and treatment procedures over time and their effects on peptic ulcer mortality.…”

Results of surgical treatment of perforated peptic ulcer

“…Another achievement in the 1980s in peptic ulcer disease (PUD) was discovery of the aetiopathogenetic role of Helicobacter pylori and introduction of eradication therapy [1,2]. However, this treatment is not successful in all patients, and lifethreatening complications of PUD in the form of haemorrhage or perforated peptic ulcer (PPU) still occur.…”

“…In Western countries a distinctly decreased number of elective operations as well as, to a lesser extent, operations performed due to haemorrhage or perforation has been observed [3,4]. However, in the same period there were some reports stating that the number of operations carried out because of PPU did not change or increased [1,5]. A growing tendency of developing perforated ulcer in women has also been noted, in elderly age in particular, as well as increasing PPU incidence in patients who were not conservatively treated previously [6].…”