scholarly journals IS LAPAROSCOPIC SURGERY BECOMING THE FIRST CHOICE IN TREATMENT OF PERFORATED PEPTIC ULCER?

2020 ◽  
Vol 2 (1) ◽  
pp. 30-35
Author(s):  
Laura Popa ◽  
Florentina Mușat ◽  
D.N. Păduraru ◽  
Alexandra Bolocan ◽  
O. Andronic
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Surgery ◽  
Operation Time ◽  
Perforated Peptic Ulcer ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
First Choice ◽  
Selection Of

Perforated peptic ulcer (PPU), a significant complication of peptic ulcer disease, has proven to be associated with high rates of mortality and morbidity and to this day, it remains a clear indication of emergency surgery. Whilst open repair remains a feasible treatment option for this complication, the development of laparoscopic surgery has brought along new perspectives, by revealing the benefits and drawbacks of this procedure and therefore raising the question whether it should be the first choice in treatment of a PPU. A literature search was performed using PubMed, Web of Science and Scopus, with the selection of relevant articles from the last 15 years. By comparing the two surgical approaches, conventional and laparoscopic, we aimed to identify the reasons laparoscopy is gaining ground as a mean of treatment of a PPU. Outcomes such as hospital stay, complication rates, use of postoperative analgesics and visual analogue scale favored laparoscopy. The most heterogeneous result was dictated by the operation time, which seems to correlate with multiple factors, a major one being the learning curve and skills this procedure requires. In addition, a significant number of papers had developed patient inclusion and exclusion criteria, which impacted the results of outcomes like morbidity and mortality. There is a lot of evidence that points to laparoscopy becoming the preferred method of treatment of a PPU, however further research is needed in order to reach a consensus.

scholarly journals P-BN10 Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes in Northern Ireland

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Bakhat Yawar ◽  
Ahmed Marzouk ◽  
Heba Ali ◽  
Alsarah Diab ◽  
Hassan Abdulrahman ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Seasonal Variation ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Peptic Ulcers ◽  
Northern Irish ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Patient Demographics ◽  
Acute Peritonitis

Abstract Background Perforated peptic ulcer disease is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in presentation of patients with perforated ulcers. Here we present this study from a Northern Irish perspective on perforated peptic ulcers. Methods A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with incidence of perforated peptic ulcers. Follow-up data was also collected. Seasons were defined as per UK Met Office. Results Results:  A total of 50 patients presented with perforated PUD. Male:female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. 14 patients (28%) were either very frail or had contained perforations and were conservatively managed. 3 deaths were noted (6%). 13 patients (26%) required ICU admission at some stage in their management. Conclusions Slight seasonal variation was noted in presentation of perforated peptic ulcers in our study with more common incidence in winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.

scholarly journals Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

2015 ◽  
Vol 100 (5) ◽  
pp. 942-948 ◽  
Author(s):  
Mutlu Unver ◽  
Özgür Fırat ◽  
Ömer Vedat Ünalp ◽  
Alper Uğuz ◽  
Tufan Gümüş ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Perforated Peptic Ulcer ◽  
Patient Characteristics ◽  
Comorbid Disease ◽  
Duration Of Symptoms ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Asa Score ◽  
Comorbid Diseases ◽  
American Society

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

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

2021 ◽  
pp. 000313482110562
Author(s):  
Sarah Lund ◽  
Kiran Kaur Chauhan ◽  
John Zietlow ◽  
Daniel Stephens ◽  
Scott Zietlow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Significant Risk ◽  
Perforated Peptic Ulcer ◽  
Complication Rates ◽  
Ulcer Disease ◽  
Operative Repair ◽  
Gastrointestinal Leak ◽  
Drain Placement

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.

scholarly journals Comparison of Retrograde Intrarenal Surgery and Laparoscopic Surgery in the Treatment of Proximal Ureteral and Renal Pelvic Stones Greater than 15 mm

Folia Medica ◽  
2020 ◽  
Vol 62 (3) ◽  
pp. 490-496
Author(s):  
Yavuz Güler ◽  
Akif Erbin ◽  
Gokhun Ozmerdiven ◽  
Ozgur Yazici
Keyword(s):  
Laparoscopic Surgery ◽  
Operation Time ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Analgesic Requirement ◽  
Stone Clearance ◽  
Surgery Group ◽  
Hospitalization Time ◽  
First Choice ◽  
Vas Scores

Introduction: There is insufficient data on which modality should be the first choice in the treatment of proximal ureteral and renal pelvic stones greater than 15 mm.Aim: To compare retrograde intrarenal surgery (RIRS) and laparoscopic stone surgery for big upper ureteral and renal pelvic stones. Materials and methods: We reviewed medical records of 163 adult patients who underwent RIRS or laparoscopic surgery for upper ureteral or renal pelvic stones &ge;15 mm between January 2013 and February 2018. A total of 121 patients were included in the study. The patients were divided into two groups as RIRS (n=58) and laparoscopic surgery (n=63) and the groups were compared with regard to their demographic, stone, and operative characteristics and postoperative outcomes and complications. Results: Both operation time and hospitalization time were significantly shorter in the RIRS group compared to the laparoscopic surgery group (p<0.001). Complete stone clearance was achieved in 44 (76%) patients in the RIRS group and in 57 (90%) patients in the laparoscopic surgery group (p=0.031). Both the VAS scores and postoperative analgesic requirement were lower in the RIRS group. Based on the modified Clavien-Dindo classification, the two groups were similar with regard to peri- and post-operative complication rates. However, the incidence of Grade 3b complications (e.g. ureteral rupture, conversion to open surgery) was significantly higher in the laparoscopic surgery group and the incidence of Grade 4b complication (urosepsis) was significantly higher in the RIRS group. Conclusions: Laparoscopic surgery can provide higher stone clearance and lower auxiliary treatment rates compared to RIRSalthough it can be more disadvantageous in terms of operative time, hospitalization time, postoperative VAS scores, and analgesic usage (narcotic and non-narcotic).

scholarly journals Small Intestine Obstruction in Patients due to Phytobezoar: Case Report of Four Patients

2016 ◽  
Vol 02 (01) ◽  
pp. 040-043
Author(s):  
V Kumar ◽  
Anupama Pujar ◽  
Ashwini Kudari ◽  
Kush Luthra
Keyword(s):  
Peptic Ulcer ◽  
Case Report ◽  
Perforated Peptic Ulcer ◽  
Definitive Treatment ◽  
Ulcer Disease ◽  
High Fiber ◽  
Fiber Diet ◽  
Barium Examination ◽  
Carcinoma Esophagus ◽  
High Fiber Diet

ABSTRACT Introduction: Bezoars are rare cause of small-bowel obstruction and lead to intraluminal obstruction. The other causes are foreign bodies, gall stones, and enteroliths. Phytobezoars are collection of non-digestible materials, usually of vegetable origin, and are most commonly found in patients with impaired gastric emptying, on high-fiber diet and with abnormal food habits.We present a case report of four patients who presented with acute intestinal obstruction, and the etiology in all these four cases was found to be a phytobezoar. The complaints of diffuse pain abdomen, vomiting, and constipation were common in all four cases. One patient had undergone a gastric pull-up surgery for carcinoma esophagus and one female had undergone bilroth1 for peptic ulcer disease. One patient was a known case of diabetes mellitus and had undergone surgery for perforated peptic ulcer few years back. Conclusion: Diagnosis of bezoars is usually confirmed by barium examination or endoscopy, and definitive treatment is surgery in case of obstruction with the removal of bezoar.

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

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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