Clinical Study of Perforated Duodenal Ulcer

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.

Comparison Transilluminated Powered Phlebectomy with the Conventional Surgical Treatment of Primary Varicose Vein of the Lower Limbs

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.