The outcome of surgery for perforated peptic ulcer in modern times

Abstract

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.

Surgical Audit of Leakage after Open Surgical Repair of Perforated Peptic Ulcer

“…In current study, out of 203 patients 145 (71.4%) were male while 58 (28.6%) were female. There were 53 (96.36%) males and 02 (3.64%) females found in the study of Vats R, et al 15 . Lee FY, et al 16 In recent study, in distribution of site of perforation, 121 (59.6%) patients had duodenal perforations while 82 (40.4%) had gastric ulcer 19 .…”

“…Lee FY, et al 16 In recent study, in distribution of site of perforation, 121 (59.6%) patients had duodenal perforations while 82 (40.4%) had gastric ulcer 19 . The study of Vats R, et al 15 found the site of perforation as 29 (63.1%) had duodenal perforations while 17 (36.9%) had gastric. In the study of Lee FY, et al 16 , duodenal perforation accounted for 344 (78.9%) cases.…”

“…The mean age in our study was 42.6±8.5 years. Vats R, et al 15 noted age as 44 years. Lee FY, et al 16 noted as 51.5±18.3 years while Siu WT, et al 17 found age as 53.8 years.…”

Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital

“…The choice of surgical technique, laparoscopy versus laparotomy, varies depending on the patient’s preoperative clinical status, surgeon expertise/preference, and location of defect, with the goal of short operative time. It has been widely reported that open abdominal surgery increases postoperative pain and is associated with higher morbidity (ventral incisional hernia rate, surgical site infection, postoperative respiratory compromise, delayed recovery times, and dehiscence) when compared to laparoscopic surgery [ 9 , 10 ]. Some studies have shown laparoscopy to lessen these postoperative variables and is associated with fewer complications (i.e., surgical site infection, length of stay (LOS), better cosmetic outcomes) than open repair [ 1 , 9 , 11 ].…”

“…It has been widely reported that open abdominal surgery increases postoperative pain and is associated with higher morbidity (ventral incisional hernia rate, surgical site infection, postoperative respiratory compromise, delayed recovery times, and dehiscence) when compared to laparoscopic surgery [ 9 , 10 ]. Some studies have shown laparoscopy to lessen these postoperative variables and is associated with fewer complications (i.e., surgical site infection, length of stay (LOS), better cosmetic outcomes) than open repair [ 1 , 9 , 11 ]. Despite these favorable outcomes, laparoscopic repair is less commonly used, owning to longer operative times in less experienced centers, higher incidence of reoperations owning to leakage at the repair site, and higher incidence of intraabdominal fluid collections secondary to inadequate lavage and the requirement of extensive surgical skill [ 12 ].…”