scholarly journals Decreased risk of liver and intrahepatic cancer in non-H. pylori-infected perforated peptic ulcer patients with truncal vagotomy: a nationwide study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shih-Chi Wu ◽  
Han-Tsung Cheng ◽  
Yu-Chun Wang ◽  
Chia-Wei Tzeng ◽  
Chia-Hao Hsu ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Asian Population ◽  
Perforated Peptic Ulcer ◽  
Truncal Vagotomy ◽  
Research Database ◽  
Cancer History ◽  
Simple Closure ◽  
H Pylori

AbstractThe vagal nervous system is central to the physiological responses and systemic diseases of the liver. We evaluated the subsequent risk of liver and intrahepatic cancer (HCC/ICC) in non-H. pylori (HP)-infected perforated peptic ulcer (PPU) patients with and without vagotomy. Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database from 2000 to 2008 were enrolled. The exclusion criteria included: (1) Multiple surgeries for PPU were received at the same admission; (2) Any cancer history; (3) Previous peptic ulcer-associated surgery; (4) HP infection history; (5) Viral hepatitis infection history; (6) Follow-up duration < 1 year; and (7) Age < 18 years. The risks of developing HCC/ICC in PPU patients with and without vagotomy were assessed at the end of 2013. To balance the baseline condition between groups, we used the propensity score matched method to select study subjects. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence interval (CI) of HCC/ICC. Before propensity score matching, 675 simple suture patients and 54 TVP patients had HCC/ICC, which corresponded to incidences of 2.11 and 0.88 per 1000 person-years, respectively. After propensity score matching, 145 simple suture patients and 54 TVP patients experienced HCC/ICC, which corresponded to incidences of 1.45 and 0.88 per 1000 person-years, respectively. The TVP patients had a 0.71 (95% CI 0.54–0.95)- and 0.69 (95% CI 0.49–0.97)-fold risk of developing HCC/ICC compared to simple suture patients before and after propensity score matching. Our findings reported that, in the Asian population, TVP decreases the risk of HCC/ICC in non-HP-infected PPU patients compared to simple closure patients. However, further studies are warranted.

scholarly journals Association of Helicobacter Pylori with Peptic Ulcer Perforation

2019 ◽  
Vol 2 (1) ◽  
pp. 4-10
Author(s):  
Sunit Agrawal ◽  
D Thakur ◽  
P Kafle ◽  
A Koirala ◽  
R K Sanjana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Patch Repair ◽  
Peptic Ulcer Perforation ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
H Pylori

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use. Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared. Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them. Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

Staged antrectomy and thoracoscopic truncal vagotomy for perforated peptic ulcer disease

1993 ◽  
Vol 55 (6) ◽  
pp. 1571-1573 ◽  
Author(s):  
Trevor C. Axford ◽  
Daniel G. Clair ◽  
Monica M. Bertagnolli ◽  
Steven J. Mentzer ◽  
David J. Sugarbaker
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Truncal Vagotomy ◽  
Ulcer Disease

scholarly journals Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

2009 ◽  
Vol 22 (1) ◽  
pp. 15-18
Author(s):  
Rosa Pachaly Dalcin ◽  
Cristiano Antoniazzi Abaid ◽  
Paola M. Almeida ◽  
Samia B. Adaime ◽  
Thiza Massaia Londero ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Treatment Protocol ◽  
Perforated Peptic Ulcer ◽  
Ulcer Recurrence ◽  
Negative Group ◽  
Positive Group ◽  
Ulcer Relapse ◽  
Significant Difference ◽  
H Pylori

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done. AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori. METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months. RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients. CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

Perforated Peptic Ulcer Treated by Simple Closure and Helicobacter Pylori Eradication

2005 ◽  
Vol 29 (7) ◽  
pp. 849-852 ◽  
Author(s):  
Juan C. Rodríguez-Sanjuán ◽  
Roberto Fernández-Santiago ◽  
Rosa A. García ◽  
Soledad Trugeda ◽  
Isabel Seco ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Perforated Peptic Ulcer ◽  
Simple Closure ◽  
Helicobacter Pylori Eradication

scholarly journals Surgical outcome of management of perforated peptic ulcer: retrospective analysis of 148 cases

2019 ◽  
Vol 6 (10) ◽  
pp. 3643
Author(s):  
Salamat Khan ◽  
O. P. Gupta
Keyword(s):  
Peptic Ulcer ◽  
Fluid Resuscitation ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Omental Patch ◽  
Hemodynamic Status ◽  
Peritoneal Drainage ◽  
H Pylori

Background: Perforated peptic ulcer (PPU) is a common life threatening surgical emergency. Discovery of H. pylori (1985) changed the concept of the management of peptic ulcer. Now-a-days reduction in gastric acid production with proton pump inhibitors along with eradication of H. pylori is recommended.Methods: Clinically suspected cases of PPU were confirmed by radiological and laboratory investigation. These patients were subjected to exploratory laparotomy with Graham’s omental patch repair after adequate fluid resuscitation with optimal hemodynamic status with or without peritoneal drainage, except in too sick patients. Postoperatively; these patients kept in SICU and closely monitored. Data were collected, tabulated and analyzed.Results: Out 150 cases enrolled, 2 cases died before exploratory laparotomy and closure of operation. So only 148 took part in the study. Male patients were predominant than female in a ratio of 148:2. Age ranges from 20 to >60 years. Majority of the patients belongs to the age group 30-40 years of age. The morbidity and mortality rates were 20% and 2.7% respectively.Conclusions: Adequate fluid resuscitation with optimal hemodynamic status and optimal kidney function is the key to decrease morbidity and mortality rates. Simple closure with omental patch followed by H. pylori eradication is effective with excellent outcome in most of survivor despite of late presentation. Old concept of prophylactic peritoneal drainage and “no sunset no sun rise” concept of operation should be discouraged as it is not beneficial. Definitive surgery for ulcer recurrence is no more done except in special situation.

scholarly journals Laparoscopic repair of perforated peptic ulcer: Patch versus simple closure

2013 ◽  
Vol 11 (9) ◽  
pp. 948-951 ◽  
Author(s):  
M.E. Abd Ellatif ◽  
A.F. Salama ◽  
A.F. Elezaby ◽  
H.F. El-Kaffas ◽  
A. Hassan ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Perforated Peptic Ulcer ◽  
Simple Closure
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