Risk Factors for Gastrointestinal Leak after Perforated Peptic Ulcer Disease Operative Repair

Background There are limited studies regarding the impact of post-operative leak on perforated peptic ulcer disease (PPUD) and conflicting results regarding routine drain placement in operative repair of PPUD. This study aims to identify risk factors for gastrointestinal leak after operative repair of PPUD to better guide intra-operative decisions about drain placement. Methods We performed a retrospective cohort study at a tertiary care center from 2008 to 2019, identifying 175 patients who underwent operative repair of PPUD. Results Patients who developed a leak (17%) were compared to patients who did not. Both hypoalbuminemia (albumin < 3.5 g/dL) ( P = .03) and duodenal ulcers ( P < .01) were identified as significant risk factors for leak. No significant difference was found between leak and no leak groups for AAST disease severity grade, repair technique, or pre-operative use of tobacco, alcohol, or steroids. Post-operative leaks were associated with prolonged hospital stay (29 days compared to 10, P < .01), increased complication rates (77% compared to 48%, P < .01), and increased re-operation rates (73% compared to 26%, <0.01). No difference was identified in patient characteristics or operative leak rates between patients who had drains placed at the index operation and those that did not. Discussion Leak after operative PPUD repair is associated with significant post-operative morbidity. Hypoalbuminemia and duodenal perforations are significant risk factors for post-operative leaks.

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Association of Helicobacter Pylori with Peptic Ulcer Perforation

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v2i1.24960 ◽

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.

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Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Turkish Journal of Surgery ◽

10.5152/ucd.2014.2705 ◽

2015 ◽

Vol 31 (1) ◽

pp. 20-25 ◽

Cited By ~ 2

Author(s):

Ilhan Tas ◽

Burak Veli Ulger ◽

Akin Onder ◽

Murat Kapan ◽

Zubeyir Bozdag

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Ulcer Disease ◽

Factors Influencing

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What are the benefits and harms of laparoscopic repair in people with perforated peptic ulcer disease?

Cochrane Clinical Answers ◽

10.1002/cca.398 ◽

2016 ◽

Author(s):

Kurinchi Gurusamy

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Laparoscopic Repair ◽

Perforated Peptic Ulcer ◽

Ulcer Disease

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The Risk Factors and Quality of Life in Patients with Overlapping Functional Dyspepsia or Peptic Ulcer Disease with Gastroesophageal Reflux Disease

Gut and Liver ◽

10.5009/gnl.2014.8.2.160 ◽

2014 ◽

Vol 8 (2) ◽

pp. 160-164 ◽

Cited By ~ 7

Author(s):

Shou-Wu Lee ◽

Teng-Yu Lee ◽

Han-Chung Lien ◽

Hong-Zen Yeh ◽

Chi-Sen Chang ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Peptic Ulcer ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Peptic Ulcer Disease ◽

Functional Dyspepsia ◽

Reflux Disease ◽

Ulcer Disease

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FEASIBILITY OF ERAS (ENHANCED RECOVERY AFTER SURGERY) PROTOCOL IN PATIENTS UNDERGOING EMERGENCY REPAIR FOR PERFORATED PEPTIC ULCER DISEASE IN A TERTIARY CARE HOSPITAL

10.36106/ijsr/1219188 ◽

2021 ◽

pp. 41-43

Author(s):

Chayan Rui ◽

Chandan Roy Choudhury ◽

Puspak Ghosh

Keyword(s):

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Tertiary Care ◽

Perforated Peptic Ulcer ◽

Patch Repair ◽

Care Hospital ◽

Ulcer Disease ◽

Emergency Repair

Introduction: The surgical treatment of perforated peptic ulcer disease has evolved in parallel to advances in medical treatment of Peptic Ulcer Disease. Objective: To investigate the feasibility of ERAS (Enhanced Recovery after Surgery) Pathways in patients undergoing emergency repair for Perforated peptic ulcer disease. Materials and methods: Institutional based prospective analytical study. Indoor patients in Dept. of General Surgery in Medical College and Hospital Kolkata. January 2019 to June 2020. Study was conducted for 18 months.14 months was provided for data collection. Next 2 months for statistical analysis and another 2 months for thesis writing and submission. Conclusion: ERAS pathway (with some modications) seems to be safe and feasible in a highly selected subset of patients undergoing emergency Omental grahams patch repair of Perforated Peptic Ulcer Disease

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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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