Abstract
Abstract
Aim. The efficacy of modern medical treatment has played an important role in decreased incidence and differentation of the epidemiology of ulcer perforation. But a similar rate of differentiation in mortality and morbidity was not observed. The effect of more simple surgical procedures and the factors associated with mortality and morbidity in ulcer perforation, were the subject of this study. Methods. The files of 126 patients who were operated due to peptic ulcer perforation between 1998 and 2005 were analyzed in retrospective manner. Patients were divided into two groups as primary repair group and definitive surgery group. Factors affecting the choice of surgical treatment, perforation etiology, predisposing factors associated with mortality and morbidity rate were evaluated. Results. A hundred and fourteen 114 (90.5%) patients were male and 12 (9.5%) of them were female. The mean age was 50.7 (± 13.5). Primary repair group included 103 (81.7%) patients whereas definitive surgery group included 23 (18.3%) patients. The overall mortality and morbidity rates in primary repair group and definitive surgery were, 3.9% and 15% respectively. Conclusion. Primary repair has re-gained popularity in time. The factors associated with mortality and morbidity were age, concomitant disease, and delayed admission.
Keywords: Urgent surgery, peptic ulcer perforation, acute abdominal pain
Özet
Amaç. Modern tedavi ile medikal peptik ülser perforasyonu insidansının azalmasına ve ülser perforasyonu epidemiyolojisinin değişmesine karşın, perforasyonlara bağlı ölüm oranlarında benzer azalma sağlanamamıştır. Bu çalışmada peptik ülser perforasyonunda gözlenen morbidite ve mortalite ile ilişkili faktörler ve daha basit cerrahi işlemlerin rolü irdelenmiştir. Yöntem. Ocak 1998-Aralık 2005 yılları arasında peptik ülser perforasyonu nedeniyle opere edilen 126 hasta, arşiv kayıtlarından retrospektif olarak incelendi. Hastalar, primer tamir ve kesin cerrahi uygulananlar olarak ikiye ayrıldı. Uygulanacak cerrahi tipini etkileyen faktörler, perforasyon etyolojisi, mortalite ve morbiditeyi etkileyen faktörler değerlendirildi. Bulgular. Hastaların 114 (%90,5)’ ü erkek, 12 (%9,5)’ si kadın olup yaş ortalaması 50,7 (±13,5) idi. Hastaların 103 (%81,7)’üne primer sütür, 23 (%18,3)’üne kesin ülser cerrahisi uygulandı. Genel mortalite oranı %3,9, genel morbidite oranı ise %15 idi. Hastaların mortalite ve morbidite ile ilişkili risk faktörlerinin yaş (>60), yandaş hastalığın varlığı ve hastaneye geç başvuru olduğu saptandı Sonuç. Peptik ülser perforasyonu cerrahisinde primer tamir zamanla yeniden popular olmuştur. Hastaneye geç başvuru, yaş, eşlik eden hastalık ve operasyon tipi morbidite ve mortalite ile ilişkili faktörler olarak bulundu.
Anahtar sözcükler: Acil cerrahi, peptik ülser perforasyonu, akut karın ağrısı
Keywords
References
- Barksdale AR, Schwartz RW. Current management of perforated peptic ulcer. Curr Surg 2000; 57: 594-9.
- Crisp E. Cases of perforation of the stomach. Lancet 1: 639; 1843.
- Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Akahoshi K, Ayukawa K, Wada H, Tanoue K, Sugimachi K. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology 2001; 48: 156-62.
- Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg 2000; 24: 277-83.
- Doherty GM, Way LW. Stomach and duodenum. In: Doherty GM, Way LW. Eds. Current surgical diagnosis and treatment. 11th ed. New York: McGraw-Hill Co, 2003; pp: 533-64.
- M.Johnston D, Martin I. Duodenal ulcer and peptic ulceration. In: Zinner JZ, Schwartz SI, Ellis H. Eds. Maingot’s abdominal operations. 10th ed. Volume 1. Connecticut: Appleton Lange 1997; pp: 941-70.
- Irvin TT. Mortality and perforated peptic ulcer: a case for risk stratification in elderly patients. Br J Surg 1989; 76: 215-8.
- Martin RF. Surgical management of ulcer disease. Surg Clın North Am 2005; 85: 907-29.
- Rajesh V, Chandra SS, Smile Sr. Risk factors predicting operative mortality in perforated peptic ulcer disease.Trop Gastroenterol 2003; 24: 148-50.
- Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter 2003; 8: 159-67.
- Chou NH, Mok KT, Chang HT, Liu SI, Tsai CC, Wang BW, Chen IS. Risk factors of mortality in perforated peptic ulcer. Eur J Surg 2000; 166: 149-53.
- Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today--indication, technique and outcome. Langenbecks Arch Surg 2000; 385: 84-96.
- Barut I, Tarhan OR, Cerci C, Karagüzel N, Akdeniz Y, Bülbül M. Prognostic factors of peptic ulcer perforation. Saudi Med J 2005; 26: 1255-9.
- Lanas A Gastrointestinal injury from NSAID therapy. How to reduce the risk of complications. Postgrad Med 2005; 117: 23-8, 31.
- Christensen A, Bousfield R, Christensen J. Incidence of perforated and bleedingpeptic ulcers before and after the induction of H2-receptor antagonists. Ann Surg 1998; 207: 4-6.
- Jamieson GG. Current status of indications for surgery in peptic ulcer disease. World J Surg 2000; 24: 256-8.
- Arıcı C, Dinçkan A, Erdoğan O, Bozan H, Çolak T. Peptic ulcer perforation: an analysis of risk factors. Ulusal Travma Derg 2002; 8: 142-6.
- Wakayama T, Ishizaki Y, Mitsusada M, Takahashi S, Wada T, Fukushima Y, Hattori H, Okuyama T, Funatsu H. Risk Factors influencing the short-term results of gastroduodenal perforation. Surg Today 1994; 24: 681-7.
Abstract
Amaç. Modern tedavi ile medikal peptik ülser perforasyonu insidansının azalmasına ve ülser perforasyonu epidemiyolojisinin değişmesine karşın, perforasyonlara bağlı ölüm oranlarında benzer azalma sağlanamamıştır. Bu çalışmada peptik ülser perforasyonunda gözlenen morbidite ve mortalite ile ilişkili faktörler ve daha basit cerrahi işlemlerin rolü irdelenmiştir. Yöntem. Ocak 1998-Aralık 2005 yılları arasında peptik ülser perforasyonu nedeniyle opere edilen 126 hasta, arşiv kayıtlarından retrospektif olarak incelendi. Hastalar, primer tamir ve kesin cerrahi uygulananlar olarak ikiye ayrıldı. Uygulanacak cerrahi tipini etkileyen faktörler, perforasyon etyolojisi, mortalite ve morbiditeyi etkileyen faktörler değerlendirildi. Bulgular. Hastaların 114 (%90,5)’ ü erkek, 12 (%9,5)’ si kadın olup yaş ortalaması 50,7 (±13,5) idi. Hastaların 103 (%81,7)’üne primer sütür, 23 (%18,3)’üne kesin ülser cerrahisi uygulandı. Genel mortalite oranı %3,9, genel morbidite oranı ise %15 idi. Hastaların mortalite ve morbidite ile ilişkili risk faktörlerinin yaş (>60), yandaş hastalığın varlığı ve hastaneye geç başvuru olduğu saptandı Sonuç. Peptik ülser perforasyonu cerrahisinde primer tamir zamanla yeniden popular olmuştur. Hastaneye geç başvuru, yaş, eşlik eden hastalık ve operasyon tipi morbidite ve mortalite ile ilişkili faktörler olarak bulundu
References
- Barksdale AR, Schwartz RW. Current management of perforated peptic ulcer. Curr Surg 2000; 57: 594-9.
- Crisp E. Cases of perforation of the stomach. Lancet 1: 639; 1843.
- Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Akahoshi K, Ayukawa K, Wada H, Tanoue K, Sugimachi K. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology 2001; 48: 156-62.
- Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg 2000; 24: 277-83.
- Doherty GM, Way LW. Stomach and duodenum. In: Doherty GM, Way LW. Eds. Current surgical diagnosis and treatment. 11th ed. New York: McGraw-Hill Co, 2003; pp: 533-64.
- M.Johnston D, Martin I. Duodenal ulcer and peptic ulceration. In: Zinner JZ, Schwartz SI, Ellis H. Eds. Maingot’s abdominal operations. 10th ed. Volume 1. Connecticut: Appleton Lange 1997; pp: 941-70.
- Irvin TT. Mortality and perforated peptic ulcer: a case for risk stratification in elderly patients. Br J Surg 1989; 76: 215-8.
- Martin RF. Surgical management of ulcer disease. Surg Clın North Am 2005; 85: 907-29.
- Rajesh V, Chandra SS, Smile Sr. Risk factors predicting operative mortality in perforated peptic ulcer disease.Trop Gastroenterol 2003; 24: 148-50.
- Gisbert JP, Pajares JM. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter 2003; 8: 159-67.
- Chou NH, Mok KT, Chang HT, Liu SI, Tsai CC, Wang BW, Chen IS. Risk factors of mortality in perforated peptic ulcer. Eur J Surg 2000; 166: 149-53.
- Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today--indication, technique and outcome. Langenbecks Arch Surg 2000; 385: 84-96.
- Barut I, Tarhan OR, Cerci C, Karagüzel N, Akdeniz Y, Bülbül M. Prognostic factors of peptic ulcer perforation. Saudi Med J 2005; 26: 1255-9.
- Lanas A Gastrointestinal injury from NSAID therapy. How to reduce the risk of complications. Postgrad Med 2005; 117: 23-8, 31.
- Christensen A, Bousfield R, Christensen J. Incidence of perforated and bleedingpeptic ulcers before and after the induction of H2-receptor antagonists. Ann Surg 1998; 207: 4-6.
- Jamieson GG. Current status of indications for surgery in peptic ulcer disease. World J Surg 2000; 24: 256-8.
- Arıcı C, Dinçkan A, Erdoğan O, Bozan H, Çolak T. Peptic ulcer perforation: an analysis of risk factors. Ulusal Travma Derg 2002; 8: 142-6.
- Wakayama T, Ishizaki Y, Mitsusada M, Takahashi S, Wada T, Fukushima Y, Hattori H, Okuyama T, Funatsu H. Risk Factors influencing the short-term results of gastroduodenal perforation. Surg Today 1994; 24: 681-7.
Details
| Primary Language | English |
|---|---|
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | June 21, 2012 |
| Published in Issue | Year 2012Volume: 34 Issue: 2 |