Surgical outcome of management of perforated peptic ulcer: retrospective analysis of 148 cases
Keywords:Perforated peptic ulcer, Peritonitis, Graham’s omental patch
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.
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