Sutura laparoscópica frente a sutura por laparotomía en úlceras gastroduodenales perforadas / Laparoscopic suture facing laparotomy suture in perforated gastroduodenal ulcers

Resumen Introducción La perforación gastroduodenal continúa siendo una urgencia quirúrgica relativamente frecuente, a pesar de los avances realizados en el tratamiento médico de la enfermedad ulcerosa. Su abordaje laparoscópico ha ido aumentando en los últimos años, aunque no se ha generalizado. Nuestro objetivo es analizar los resultados postoperatorios en pacientes con úlcera perforada tratados mediante sutura laparoscópica, y compararlos con un grupo similar con sutura por laparotomía. Mantenemos la hipótesis de que la sutura laparoscópica es una opción segura y con menor morbilidad que el abordaje por laparotomía. Material y Métodos Análisis retrospectivo comparativo de dos cohortes de pacientes: una tratada mediante sutura laparoscópica durante los años 2014 y 2015, período en el que este abordaje estaba plenamente implantado en la Urgencia en nuestro hospital, y otro grupo comparable tratado mediante sutura por cirugía abierta durante el período 2001-2003. Se analizaron las complicaciones según la clasificación de Clavien-Dindo, tasa de conversión, estancia media y mortalidad. Resultados Los grupos eran comparables en edad, sexo, comorbilidades y riesgo anestésico. Se observó una tendencia a la superioridad a favor del abordaje laparoscópico en ciertas variables analizadas, con una tasa de conversión de un 3%. La presencia de complicaciones postoperatorias precoces fue mayor en el grupo con sutura por laparotomía: shock séptico postquirúrgico (15,2 % vs 6%) e infección de herida (15,2 % vs 3%), así como las complicaciones médicas, aunque de forma no significativa. El grupo tratado con sutura laparoscópica tuvo un mayor tiempo quirúrgico, menor estancia media y menor mortalidad. Conclusión La sutura laparoscópica de la úlcera gastroduodenal en nuestro centro ha tenido una baja tasa de conversión y una morbilidad algo menor a la sutura por laparotomía, con una menor tasa de reintervenciones y menor estancia media, a pesar de un mayor tiempo quirúrgico.

Introduction Gastroduodenal perforation continues to be a relatively frequent surgical emergency, despite advances in the medical treatment of ulcer disease. Its laparoscopic approach has been increasing in the last years, although it has not been generalized. Objective Was to analyze the postoperative results in patients with perforated ulcer treated with laparoscopic suture, and to compare them with a similar group with laparotomy suture. Our hypothesis was that laparoscopic suture is a safe option and with less morbidity than the laparotomy approach. Material and Methods Comparative retrospective analysis of two patient cohorts: one treated with laparoscopic suture during 2014 and 2015, a period in which this approach was fully implanted in the emergency room in our hospital, and another comparable group treated by suture for open surgery during the period 2001-2003. Complications were analyzed according to Clavien-Dindo classification, conversion rate, mean stay and mortality. Results The groups were comparable in age, sex, comorbidities and anesthetic risk. There was a trend towards superiority in favor of the laparoscopic approach in certain variables analyzed, with a conversion rate of 3%. The presence of early postoperative complications was greater in the laparotomy suture group: post-surgical septic shock (15.2% vs 6%) and wound infection (15.2% vs 3%), as well as medical complications, although not significantly. The group with laparoscopic suture had a longer surgical time, lower mean stay and lower mortality. Conclusion The laparoscopic suture of the gastroduodenal ulcer in our center has had a very low conversion rate and a somewhat lower morbidity to the laparotomy suture, with a lower rate of reinterventions and a mean stay, despite a longer surgical time.

Eficacia de sutura y epiploplastia con tratamiento médico posterior en la úlcera perforada / Epiploplasty and Suture Efficiency Using Further Medical Treatment in Perforated Ulcer

Introducción: la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior para erradicar el Helicobacter pylori, ha disminuido la recurrencia de la úlcera péptica, lo cual renueva el interés en este proceder ante las técnicas definitivas. Objetivos: determinar la eficacia a mediano plazo de este proceder en pacientes operados de úlcera péptica perforada. Métodos: se realizó un estudio observacional analítico en el Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2010 hasta diciembre de 2013. El estudio estuvo conformado por los pacientes operados de úlcera perforada con más de un año de evolución (45 casos). Los datos obtenidos se procesaron mediante el paquete estadístico SPSS para Windows versión 15.0, con técnica estadística de comparación de la prueba de hipótesis de proporciones en una computadora Pentium IV. Resultados: el sexo más afectado fue el masculino y predominó en la cuarta y quinta décadas de la vida. La localización más frecuente de la perforación fue duodenal y la mayoría, menores de 1 cm. Las complicaciones posoperatorias más frecuentes fueron las infecciones respiratorias. El tabaquismo y la ingestión de café fueron los factores de riesgo actuales más frecuentes. La mayoría de los pacientes recibieron tratamiento médico completo en el posoperatorio, con buenos resultados de acuerdo a la clasificación de Visick y en la endoscopia realizada, donde solo una paciente presentó enfermedad ulcerosa. Conclusiones: se comprobó que la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior completo es eficaz a mediano plazo(AU)

Introduction: suture and epiploplasty of perforated ulcer using further medical treatment for helicobacter pylori eradication has decreased recurrence of peptic ulcer, renewing interest in this proceeding in contrast to final techniques. Objective: determine the medium term efficacy of this procedure in patients undergoing surgery for perforated peptic ulcer. Methods: an observational study was conducted at Manuel Ascunce Domenech University Hospital in Camagüey, from January 2010 to December 2013. The study consisted of patients operated on for perforated ulcer over a year (45 cases). The obtained data were processed using SPSS for Windows version 15.0, with statistical technique of comparing the proportions hypothesis test on a Pentium IV computer. Results: the most affected patients were male aging forty and fifty. The most frequent location was duodenal perforation and most of them less than 1 cm. The most frequent postoperative complications were respiratory infections. Smoking habits and coffee intake were the most common risk factors. Most patients received full medical treatment in the postoperative period, with good results according to Visick classification and the endoscopy, where only one patient had ulcer disease. Conclusions: suture and perforated ulcer epiploplasty with subsequent full medical treatment, definitively, cure patients(AU)

Úlcera marginal perforada post bypass gástrico laparoscópico / Perforated marginal ulcer after laparoscopic gastric bypass

Introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. Material and Methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. Results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro-jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. Conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

Introducción: La perforación de una úlcera marginal es un evento grave que suele requerir una reoperación y se asocia a morbimortalidad. El manejo de estos pacientes es debatido y complejo. Objetivo: Describir una serie de pacientes operados de bypass gástrico laparoscópico (BPGLP) que evolucionaron con una úlcera marginal perforada. Material y Método: Se revisaron retrospectivamente las fichas de pacientes operados de BPGL los últimos 10 años y que evolucionaron con una úlcera marginal perforada. Se analizaron las características clínicas, de tratamiento y morbimortalidad perioperatoria. Resultados: Durante este período se operaron 2.095 pacientes de BPGLP, 12 de los cuales presentaron una úlcera marginal perforada, correspondientes a 10 mujeres y 2 hombres. El promedio de edad fue 39 años (21-60) y el índice de masa corporal (IMC) promedio al momento de la primera cirugía fue 34 (29,3-38,6). Diez pacientes tenían hábito tabáquico activo al momento de la perforación. La ocurrencia de esta sucedió en promedio a los 27 meses (rango 3-54, mediana 23,5) de la cirugía. En 11 casos la resolución fue quirúrgica, mediante abordaje laparoscópico en 9 y laparotomía en 2. En todos los casos se encontró una úlcera perforada en la vertiente yeyunal de la gastro-yeyuno anastomosis. No hubo mortalidad ni morbilidad asociada a la cirugía. Conclusiones: En nuestra experiencia la ocurrencia de úlcera marginal perforada post BPGLP se desarrolla en un bajo porcentaje de pacientes. El abordaje laparoscópico es de elección, presentando una baja morbimortalidad. El hábito tabáquico estuvo presente en la mayoría de los pacientes.

Utilidad de la puntuación de boey y portsmouth-possum fisiológico en pacientes con úlcera péptica perforada / Performance of boey score and physiologic portsmouth-possum in patients with perforated peptic ulcer

Introduction: Surgical scores such as Boey and physiologic Portsmouth-POSSUM have been independently applied to patients with perforated ulcer to stratify their surgical risk. However, there are no studies comparing both scores. The purpose of this study was to compare the performance of Boey score and Portsmouth-POSSUM in patients with perforated peptic ulcer. Methods: A retrospective comparative study was performed including 108 consecutive patients older than 15-years submitted to emergency surgery from January 2002 to June 2012. Patients operated on for perforated gastric cancer were excluded. The primary outcome measure was to compare the performance of Portsmouth-POSSUM and Boey score. Secondary outcome measures were to determine cutoff points for Portsmouth-POSSUM, Boey score, C-reactive protein (CRP), and white blood cells (WBC) count, to predict patients at risk for complications. Results: The best cutoff point for CRP was 37.5 mg/l, and for WBC was 11.600 mm³ (OR 2.9 and 4.4). The best cutoff point for physiologic Portsmouth-POSSUM was 14, for surgical Portsmouth-POSSUM were 12, and for predictive Portsmouth-POSSUM was 0.8 percent. A time of perforation higher than 24 h had an OR of 35, and Boey score of 3 had an OR of 38.3. When Boey score was 2, with preoperative shock and time of perforation higher than 24 h being the positive variables, the OR was 194.3. Conclusions: Boey score performed better than Portsmouth-POSSUM, remaining a more specific score to stratify patients submitted to emergency surgery for perforated peptic ulcer.

Introducción: Puntuaciones pronósticas como la de Boey y el Portsmouth-POSSUM han sido utilizadas en pacientes con úlcera perforada para estratificar el riesgo quirúrgico. No existen estudios que comparen ambas puntuaciones. El objetivo del presente estudio es el de comparar el rendimiento de estas puntuaciones en pacientes con úlcera péptica perforada. Métodos: Se diseñó un estudio comparativo retrospectivo que incluyó 108 pacientes consecutivos mayores de 15 años sometidos a cirugía de urgencia entre enero de 2002 y junio de 2012. Se excluyeron pacientes operados por cáncer gástrico perforado. El objetivo principal fue comparar el rendimiento de la puntuación de Boey con Portsmouth-POSSUM. Los objetivos secundarios fueron determinar los puntos de corte para Portsmouth-POSSUM, puntuación de Boey, proteína C-reactiva (PCR) y recuento de leucocitos (RL) como factores predictivos de riesgo. Resultados: El mejor punto de corte para PCR fue 37,5 mg/l y para RL 11.600 mm³ (OR 2,9 y 4,4). El mejor punto de corte para Portsmouth-POSSUM fisiológico fue 14, para Portsmouth-POSSUM quirúrgico fue 12 y para Portsmouth-POSSUM predictivo fue 0,8 por ciento. Un tiempo de perforación mayor a 24 h tenía un OR de 35 y un puntaje de Boey de 3 tenía un OR de 38,3. Cuando el puntaje de Boey fue 2 con las variables choque preoperatorio y perforación mayor a 24 h, el OR fue 194,3. Conclusiones: La puntuación de Boey presentó mejor rendimiento que Portsmouth-POSSUM, representando una puntuación más específica para estratificar pacientes sometidos a cirugía de urgencia por úlcera perforada.

Perforated peptic ulcer a review of 36 cases

To evaluate the epidemiology of peptic ulcer perforation in Armed Forces and further management / outcome of the patients. Data of 36 patients with perforated peptic ulcer collected. This data was analyzed on SPSS 13. CMH Rawalpindi from Jan 1979 to July 1981, Jan 1985 to Dec 1987 and Jan 2001 to Dec 2003. Out of 36 patients 35 were male and only one was female. Twenty four [67%] were between 31-50 years. No past history was taken from eight [22%] patients. Thirty four [94%] patients presented with duodenal perforation. Twenty patients [55%] had rigidity all over abdomen and peristalsis were present in ten [28%] patients who reported within twelve hours. Seventy eight [78%] were diagnosed by history and simple radiological examination. All the patients were treated by laparotomy [simple closure with omental patch]. Post operative complications occur in ten [28%] patients and mortality rate was 8%. Predominantly the peptic ulcer perforation occurs between 30-50 years of age. The incidence reduces with succeeding years of study. Post operative complications were less in younger age group .Early diagnosis can be made easily by taking good history and performing simple radiological examination

Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer

Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Seventeen [4%] patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention

Resultados del tratamiento de la úlcera péptica perforada / Treatment of performed peptic ulcer: results

INTRODUCCIÓN. En nuestro hospital la úlcera péptica perforada tiene una elevada morbilidad y mortalidad, mayor del 20 por ciento en los últimos 5 años, lo que nos motivó a realizar este trabajo. MÉTODOS. Se realizó un estudio descriptivo y prospectivo de los pacientes tratados por úlcera péptica perforada en el Servicio de Cirugía General del Hospital Universitario Manuel Ascunce Domenech de Camagüey, durante los años 2006 y 2007. RESULTADOS. La úlcera péptica perforada predominó en los hombres entre 40 y 59 años de edad. El 41,2 por ciento tenían antecedentes de úlcera péptica, aunque solo la mitad recibía tratamiento médico. La mayoría de los pacientes fueron atendidos entre 13 y 24 h del inicio de su cuadro clínico, y hubo pocos casos de shock, deshidratación u otra enfermedad grave asociada. La úlcera duodenal perforada fue la más frecuente (67,6 por ciento) y la sutura y la epiploplastia fueron las técnicas quirúrgicas más usadas. La mortalidad fue del 5,9 por ciento, debida a falla múltiple de órganos y sepsis respiratoria grave. CONCLUSIONES. El índice de complicaciones y la mortalidad en nuestra serie fueron bajos, dada la adopción de medidas encaminadas a tratar adecuadamente el shock y las enfermedades graves asociadas, a disminuir el tiempo preoperatorio y a revisar las técnicas quirúrgicas empleadas, incluido el lavado peritoneal(AU)

INTRODUCTION: In our hospital, performed peptic ulcer has a high morbidity and mortality, greater than 20 percent during last 5 years, motivating us to perform this paper. METHODS: Authors made a prospective and descriptive study of patients treated by performed peptic ulcer in General Surgery Service of Manuel Ascunce Domenech University Hospital of Camaguey province during 2006 and 2007. RESULTS: Perforated peptic ulcer had a predominance in men aged between 40 and 59. The 41, 2 percent of them had backgrounds of peptic ulcer although only half received medical treatment. Most of patients were seen between 13 and 24 hours of clinical picture start, and there were few shock cases, dehydration or another associated severe disease. Perforated peptic ulcer was the more frequent (67, 6 percent) suture and epiploplasty, were the more used surgical techniques. Mortality was of 5,9 percent due to multiple organ failure and severe respiratory sepsis. CONCLUSIONS: Index of complications and mortality in our series were low, according to application of measures aimed to treat properly shock and the associated severe diseases, to decrease preoperative time, and to review surgical techniques used, including peritoneal lavage(AU)

Perforated Peptic Ulcer Disease at Kenyatta National Hospital; Nairobi

Background: Published reports on perforated peptic ulcers indicate increasing rates for the elderly; those chronically ill and females. Our local observations are at variance. This study analysed patients treated for peptic ulcer perforations at the Kenyatta National Hospital between January 2005 and December 2006. Methods: Clinical charts for patients admitted and treated for perforated peptic ulcer disease were reviewed. Data sought included patient demographic data; clinical presentation; and time from onset of symptoms to treatment; operative findings and treatment mplications. The determinants of post-operative complications were evaluated using univariate analysis. Results: Forty four patients with perforated ulcers were admitted and treated over a two year study period. Twenty eight were analyzed (retrieval rate 63.6). Males (86.2) and those 35 years of age and younger (57.1) predominated. Alcohol; smoking and prior use of non steroidal anti inflammatory drugs were respectively documented in 39.3; 39.3and 10.7of patients. The complication rate was 25. Four patients died. The factors significantly related to complications was treatment delay (p=0.007) and acute perforation (0.027) Conclusion: Perforated peptic ulcer disease is a disease of young males. Efforts to reduce delay in presentation in this population may reduce the complications

Ulcus péptico perforado: revisión de 102 casos en el Hospital Dr. "Domingo Luciani" / Perforated peptic ulcer: a review of 102 cases at the Hospital Dr. Domingo Luciani

Determinar los aspectos epidemiológicos y el tratamiento quirúrgico en los pacientes con ulcus péptico perforado atendidos en el Departamento de Cirugía General del Hospital Domingo Luciani. IVSS, Caracas. Estudio retrospectivo, transversal, descriptivo y observacional, realizado en el período correspondiente de julio de 1989 a julio de 2007, mediante la revisión de historias clínicas de pacientes intervenidos quirúrgicamente por ulcus péptico perforado. Un total de 102 pacientes fueron intervenidos por ulcus péptico perforado, en su mayoría hombres (90 por ciento), con edad promedio de 40 años. El principal síntoma fue el dolor. Los pacientes acudieron en las primeras 24 horas del inicio de los síntomas. Los antecedentes más importantes fueron el hábito tabáquico y alcohólico (62 por ciento y 56 por ciento). La localización más frecuente de la úlcera fue prepilórica (64 por ciento). La técnica de reparación quirúrgica más empleada fue la rafia de la úlcera más parche de epiplón (44 por ciento). La morbilidad fue de 27.5 por ciento y la mortalidad de 5 por ciento. El ulcus péptico perforado se presenta con mayor frecuencia en hombres fumadores. La raparación quirúrgica con rafia y parche de epiplón es segura.

Management of perforated peptic ulcer in Al-Gamhouria teaching hospital, Aden

We aimed to explore and analyze the current status in management of patients with perforated peptic ulcers. The study was carried out at the surgical department of Al-Gamhouria Teaching Hospital, Aden-Yemen. Patients, admitted with perforated benign peptic ulcers, during the period January 1997 to December 2006, were retrospectively evaluated. The total number of enrolled patients was 156; 138 [88.46%] men and 18 [11.54%] women. Overall mean age was 39.08 years [range 14-75 years] and the higher frequency of PPU was in patients of age group 21-40 years [58.34%]. The PDU/PGU ratio was [4.38:1]. The mean time of presentation was 16.5 hours and of the operative intervention after admission was 525 hours. Simple perforation closure was used in [91.67%] of the patients. Postoperative complications rate was 41.03% [statistically significant in cases admitted later than 12 hours], wound sepsis making the majority-55.24%; died 6 patients [3.85%]-correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.74% of the patients stayed more than 3 weeks. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Improving the surgical skills, wound care, administrative regulations, hospital environment and equipments is needed to reduce the high rate of complications

[Laparoscopic treatment of duodenal ulcer feasibility and results: about 160 cases]

The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer. One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists of a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pump was conducted. The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min [extremes 50 - 120 min]. Complications occur in 3.1%. There were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occured in 4 cases because of no adhesion to medical treatment. Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness

[Laparoscopic management of perforated duodenal ulcers results of a retrospective study]

Perforation of peptic duodenal ulcer is a frequent surgical emergency. The aim of this retrospective study is to evaluate the faisabiity and the results of laparoscopic management of perforated duodenal ulcers. Eighty-four patients had laparoscopic surgery for perforated duodenal ulcer. The duration of the study was seven years [2001 to 2007]. There were 81 men and 3 women aged from 16 to 64 years [mean: 28 years]. The mean duration between the onset of perforation and the time of operation was 20 hours [range: 6-72 hours]. The surgical procedure was suture and irrigation of the abdominal cavity. Conversion into laparotomy was performed in 14.2%of the patients. Mean operative time was 95 minutes. There was no post operative death. The morbidity rate was 15.4%. There was two surgical complications [post operative peritonitis and duodenal fistula] and ii medical complications. Mean hospital stay was 6 days. All patients were discharged with antibiotics for Helicobacter pylon eradication. Laparoscopic repair of perforated duodenal ulcer is a safe option providing low rates of morbidity, reoperation and mortality, and can be considered as the treatment of choice

Perforación gastroduodenal por ulcera péptica: estudio de 99 pacientes operados / Perforated gastroduodenal peptic ulcer: a study of operated patients

Se realizó un estudio de los pacientes operados por úlcera péptica gastroduodenal perforada en el Hospital Provincial Docente Clinicoquirúrgico Dr. Ambrosio Grillo Portuondo (Santiago de Cuba), entre los años 2000 y 2006. En el estudio predominaron los pacientes en la tercera década de la vida (30,3 por ciento) y el sexo masculino (90 por ciento). En la mayoría de los pacientes (68,7 por ciento) la perforación fue una complicación de enfermedad ulcerosa y predominó entre ellos el nivel medio de escolaridad (67,7 por ciento). Tenían más de un hábito tóxico 72 por ciento de los pacientes. El procedimiento más realizado fue la vagotomía troncular con piloroplastia (82,8 por ciento). No hubo complicaciones posoperatorias en 77,7 por ciento de los operados y la mortalidad global fue de 98 por ciento(AU)

A study was conducted on 99 patients operated from perforated gastroduodenal peptic ulcer at Dr Ambrosio Grillo Portuondo provincial teaching clinical and surgical hospital in Santiago de Cuba province in the period from 2000 to 2006. Thirty years age group (30,3 per cent), males (90 per cent)and intermediate level schooling prevailed. Perforation was a complication of ulcerous disease in most of the patients (68,7 per cent). More than one toxic habit was found in 72 per cent of patients. The most performed procedure was troncular vagotomy with piloroplasty (82,8 per cent). There was no postoperative complication in 77,7 per cent of the operated patients and the global mortality was 98 cent(AU)

Estado actual del tratamiento quirúrgico de la úlcera péptica perforada en el Hospital Regional de Talca: Experience of a regional hospital / Emergency surgical treatment of perforated peptic ulcer

La perforación de una úlcera péptica corresponde a una infrecuente y siempre grave complicación de la enfermedad ulcerosa. El tratamiento quirúrgico es la terapia de elección. Se operaron 22 pacientes (21 hombres) con una edad promedio de 50 años. Tres enfermos tenían el diagnóstico de úlcera péptica previo a la emergencia actual. El síntoma más frecuente de consulta fue el dolor epigástrico de inicio súbito en 21 (95,4 por ciento) pacientes. El diagnóstico se realizó con radiografía de tórax de pie o de abdomen simple en 11 enfermos. Se realizó sutura simple de la úlcera en 12 (54,5 por ciento) pacientes, sutura más epiploplastía en 7 (31,8 por ciento) y resección gástrica en tres enfermos (13,6 por ciento). Siete (31,8 por ciento) pacientes presentaron complicaciones post operatorias, de los cuales fallecieron 2 (9,1 por ciento) como consecuencia de la sepsis asociada. Se realizó un seguimiento endoscópico a 9 pacientes (45 por ciento) sobrevivientes al episodio agudo. En 5 de ellos se demostró que la úlcera péptica aun permanecía activa. A dos de estos últimos pacientes se les realizó, en forma electiva una cirugía resectiva definitiva. Se concluye que la perforación de una úlcera péptica corresponde a un cuadro grave, que se asocia a una morbilidad y mortalidad significativa. El tratamiento quirúrgico local es la terapia de elección para el episodio agudo, sin embargo este no es definitivo y no evita la recidiva.

Background: Peptic ulcer perforation is an uncommon by devastating complication that requires emergency surgical treatment. Aim: To review the results of surgical treatment of peptic ulcer perforation in a Chilean Regional Hospital. Material and Methods: Retrospective review of medical records of 22 patients (age range 21-88 years, 21 males) operated for a perforated peptic ulcer, between 1995 and 2000. Results: The most common presentation symptom was acute epigastric pain in 21 patients. The diagnosis was done with a plain abdominal X ray obtained in the standing position, in 11 patients. A simple suture of the ulcer was done in 12 patients, suture plus epiploplasty in seven and gastric resection in three. Seven patients (32 percent) had postoperative complications and two (9 percent) died as a consequence of an associated septic process. An endoscopic follow up was done in nine patients and in two, the peptic ulcer remained active. These two patients were subjected to an elective excisional surgery. Conclusions: Local surgical correction of peptic ulcer perforation is the emergency treatment of choice but does not avoid ulcer relapse.

Reparación videolaparoscópica con parche de epiplón en pacientes con úlceras gastroduodenales perforadas: primera experiencia en el Hospital Universitario de Caracas / Laparoscopic repair with omental patch in patients with perforated gastroduodenal ulcers: first experience at the Hospital Universitario de Caracas

El objetivo de este trabajo consistió en aplicar por primera vez en nuestro hospital la técnica laparoscópica de reparación de úlcera gastroduodenal perforada con cierre primario y colocación de parche de epiplón mediante la confección de nudos intracorpóreos a 8 pacientes masculinos, con edades comprendidas entre los 28 y los 74 años, que consultaron a la emergencia del Hospital Universitario de Caracas, con cuadro clínico de abdomen agudo sugestivo de perforación gastroduodenal, en el período comprendido entre noviembre de 2003 y septiembre de 2004. La edad promedio fue 48 años. El tiempo de evolución clínica osciló entre 6 y 48 horas, con un promedio de 11,31 horas. El tiempo operatorio promedio fue 160 minutos. En promedio el dolor posoperatorio fue de 2/10 según EVA (escala visualanalógica para dolor). El promedio de hospitalización fue de 7,85 días. El reintegro a las actividades cotidianas fue en promedio de 13 días. No hubo necesidad de conversión a técnica abierta en ningún caso. Se presentaron complicaciones en 2 pacientes, uno de ellos por reapertura del cierre primario y otro quien presentó colección intrabdominal, ambos fueron reintervenidos de forma abierta, sin complicaciones ulteriores. No hubo mortalidad. La reparación videolaparoscópica constituye un método seguro y efectivo, con excelente resultado estético y menor dolor posoperatorio, por lo que se recomienda ampliamente para el tratamiento de emergencia de los cuadros de úlcera gastroduodenal perforada.

The objective of this work consist to apply for first time in our hospital the laparoscopic repair technique for perforated gastroduodenal ulcers with primary closure and ommental patch using intracorporeal knots. Eight male patients were consults to emergency room of Hospital Universitario de Caracas with ages between 28 and 74 years old, presents clinical syndrome of acute abdomen suggest of perforated gastroduodenal ulcer within period of 2003 November to 2004 September. The mean age was 48 years old. The clinical evolution time before surgery was oscillate between 6 and 48 hours with mean of 11.31 hours. Mean surgery time was 160 minutes. Postoperative pain was 2/10 according to VAS (visual-analog scale for pain). Mean hospitalization days was 7.85 days. Reintegration to daily activities was in mean 13 days. There was not need to conversion to open technique in any case. There were complications in two patients, one of them with reopened of repair site and the other with intrabdominal collection, both were operated in open way without posterior complications. No mortality was occurs. Laparoscopic repair method is secure and effective with excellent cosmetic results and less postoperative pain so we recommended for emergency treatment of perforated gastroduodenal ulcer.

Duration between perforation and operation affecting the prognosis duodenal ulcer perforation

To describe the effect of perforation-operation interval on the prognosis of perforated duodenal ulcer. This descriptive study was conducted in surgical units of Nishtar Hospital, Multan during the period of two year from January 2004 to December 2005. There were 100 patients in study. All patients were divided into three groups according to perforation operation interval. In 58% of patients surgery was performed after 24 hours. Overall mortality of 16% in 50 patients was observed who underwent surgery. Mortality occurred only in group-B and C. Increased interval between perforation and operation increases stay in hospital. Number of complications in patients presenting with delay were much more than in patients presenting early. Morbidity rises with delay. Patients with perforated duodenal ulcers should he operated on as soon as possible. Simple closure of perforation is simple and safe with relativity low mortality and short stay in hospital

Laparoscopic management of perforation of a manginal ulcer following anterior gastrojejunostomy

Marginal ulcer is a well-known complication following gastrojejunostomy especially if vagotomy is not done or is incomplete and in anterior gastrojejunostomies. We report a case of marginal ulcer perforation in a 45-year old male who presented with peritonitis and a history of undergoing surgery for peptic ulcer disease 20 years back. Diagnostic laparoscopy revealed extensive soiling and a 1.5cm perforation on the efferent Loop of an anterior gastrojejunostomy Laparoscopic closure was done. There are only few reports of similar conditions published in the literature. With experience, it is feasible to use laparoscopy for the management of uncommon acute conditions like this one

Is there any role of acid reducing gastric surgery in peptic ulcer perforation?

Helicobacter pylori (H. pylori) is known to be the prime factor of peptic ulcer disease as well as NSAID usage. Although medical treatment of the bacteria can eliminate the problem for more than 90% of the infected people but the cost of treatment is high then acid reducing gastric surgery still has a definite role. The prevalence of H. pylori in peptic ulcer perferation is still unknown also whether vagotomy and gastrectomy could eradicate H. pylori. Now laparoscopic surgery especially the simple repair of the perforation has became routinely used in many part of the world. So acid reducing gastric surgery is a good choice in chronic user of NSAID and also an option for people who have H. pylori infection.