Primary closure versus Graham patch omentopexy in perforated peptic ulcer: A systematic review and meta-analysis

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

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Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2019-000350 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000350

Author(s):

Sarah Peiffer ◽

Matthew Pelton ◽

Laura Keeney ◽

Eustina G Kwon ◽

Richard Ofosu-Okromah ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Low Income ◽

Meta Analysis ◽

Mortality Rates ◽

Sub Saharan Africa ◽

Perioperative Mortality ◽

Ulcer Disease

IntroductionIn 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries.ObjectiveTo assess perioperative mortality rates from complicated PUD in Africa and associated risk factors.DesignWe performed a systematic review and a random-effect meta-analysis of literature describing surgical management of complicated PUD in Africa. We used subgroup analysis and meta-regression analyses to investigate sources of variations in the mortality rates and to assess the risk factors contributing to mortality.ResultsFrom 95 published reports, 10 037 patients underwent surgery for complicated PUD. The majority of the ulcers (78%) were duodenal, followed by gastric (14%). Forty-one per cent of operations were for perforation, 22% for obstruction and 9% for bleeding. The operations consisted of vagotomy (38%), primary repair (34%), resection and reconstruction (12%), and drainage procedures (6%). The overall PUD mortality rate was 6.6% (95% CI 5.4% to 8.1%). It increased to 9.7% (95% CI 7.1 to 13.0) when we limited the analysis to studies published after the year 2000. The correlation was higher between perforated PUD and mortality rates (r=0.41, p<0.0001) than for bleeding PUD and mortality rates (r=0.32, p=0.001). Non-significant differences in mortality rates existed between sub-Saharan Africa (SSA) and North Africa and within SSA.ConclusionPerioperative mortality rates from complicated PUD in Africa are substantially high and could be increasing over time, and there are possible regional differences.

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