Research Article
BibTex RIS Cite

Peptik Ülser Perforasyonu Nedeniyle Opere Edilen Hastaların Retrospektif Analizi: Tek Merkez Sonuçları

Year 2022, , 188 - 192, 15.10.2022
https://doi.org/10.53446/actamednicomedia.1132705

Abstract

Giriş
Peptik ülser perforasyonu aşırı mide asidi üretimi veya azalmış mukozal savunma nedeniyle gastrointestinal sistem mukozasında gelişen tam kat defektler sonucu oluşur. Peptik ülser perforasyonunda tanı ve tedavisinin gecikmesi nedeniyle mortalite ve morbidite artmaktadır. Bu çalışma ile kliniğimizde peptik ülser perforasyonu nedeniyle cerrahi uygulanan hastalarla ilgili deneyimimizi aktarmayı planladık.
Gereç-Yöntem
Çalışmamızda kliniğimizde Mayıs 2020 ile Ocak 2022 tarihleri arasında peptik ülser perforasyonu nedeniyle cerrahi uygulanan hastaların verileri retrospektif olarak incelenmiştir.
Bulgular
Çalışmaya 4’ü (%20) kadın, 16’sı (%80) erkek olmak üzere toplam 20 hasta alındı. Hastaların medyan yaşları 47,5 (27-90) idi. Medyan ameliyat süresi 45 (30-75) dakika idi. Hastaların 17’sinde (%85) defekt omental yama ile onarılırken 3’ünde (%15) ise falsiform ile yama yapıldı. Hastanede kalış süresi ortalama 3,5 (2-5) gün idi.
Sonuç
Peptik ülser perforasyonunda tedavisinde uygulanacak cerrahi teknikler çeşitli olup, en sık tercih edilen yöntem laparoyomiyle omental yama onarımıdır. Perforasyonun tekrarlanmasını önlemek için Helicobacter pylori eradikasyon tedavisi ve kontrolü yapılmalıdır.

References

  • 1. Lanas A, Chan FKL: Peptic ulcer disease. Lancet. 2017, 390:613-24. 10.1016/S0140-6736(16)32404-7
  • 2. Zelickson MS, Bronder CM, Johnson BL, Camunas JA, Smith DE,Rawlinson D, Von S, Stone HH, Taylor SM. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. AmSurg 2011; 77: 1054-1060 [PMID: 21944523]
  • 3. Hernández-Díaz S, Rodríguez LA. Association between non steroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the1990s. Arch Intern Med 2000; 160: 2093-2099 Doi: 10.1001/archinte. 160.14.2093
  • 4. Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9(1):1-12. doi:10.4240/wjgs.v9.i1.1
  • 5. Kitagawa Y, Dempsey DT. Stomach. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e. McGraw Hill; 2015.
  • 6. Saverio S, Bassi M, Smerieri N, et al. “Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper.” World Journal of Emergency Surgery : WJES 9 (2014): 45 – 45
  • 7. Kim HC, Yang DM, Kim SW, Park SJ: Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time. Eur Radiol. 2014, 24:1386-93. 10.1007/s00330-014-3115-z
  • 8. Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, Søreide JA. Perforated peptic ulcer. Lancet. 2015 Sep 26;386(10000):1288-1298. doi: 10.1016/S0140- 6736(15)00276-7.
  • 9. Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013 Apr 10;21:25. doi: 10.1186/1757-7241-21-25
  • 10. Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987; 205: 22-26 [PMID: 3800459 DOI: 10.1097/00 000658-198701000-00005]
  • 11. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518-26.
  • 12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004 Aug 1;240(2):205-13.
  • 13. Tas I, Ulger BV, Onder A, Kapan M, Bozdag Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg. 2015;31(1):20–5.
  • 14. Dadfar A, Edna TH. Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. World J Gastroenterol. 2020 Sep 21;26(35):5302-5313.
  • 15. Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg. 2015;10(1):7–13.
  • 16. Koc M, Yoldas O, Kılıc Y, Gocmen E, Ertan T, Dizen H, et al. Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer. Langenbecks Arch Surg. 2007;392(5):581–5.
  • 17. Ölmez A, Çiçek E, Aydın C, Kaplan K, Kayaalp C. Omentopexy versus falciformopexy for peptic ulcer perforation. Ulus Travma Acil Cerrahi Derg. 2019 Nov;25(6):580-584.
  • 18. Kwan JR, Lim M, Ng F, Shelat V. Fungal Isolates in Peritoneal Fluid Culture Do Not Impact Peri-Operative Outcomes of Peptic Ulcer Perforation. Surg Infect (Larchmt). 2019 Dec;20(8):619-624.
  • 19. Huston JM, Kreiner L, Ho VP, Sanders JM, Duane TM. Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions. Surg Infect (Larchmt). 2019 Dec;20(8):593-600.

Retrospective Analysis of Patients Operated for Peptic Ulcer Perforation: Single Center Results

Year 2022, , 188 - 192, 15.10.2022
https://doi.org/10.53446/actamednicomedia.1132705

Abstract

Introduction
Peptic ulcer perforation is a full-thickness defect in mucosa due to excessive gastric acid production or decreased mucosal defense. Mortality and morbidity increase in peptic ulcer perforation due to delayed diagnosis and treatment. This study aimed to present our experience with patients who underwent surgery for peptic ulcer perforation in our clinic.
Material-Method
The data of patients who underwent surgery for peptic ulcer perforation between May 2020 and January 2022 in our clinic were retrospectively analyzed.
Results
A total of 20 patients, 4 (20%) female and 16 (80%) male were included in the study. The median age of the patients was 47.5 (27-90). The median operative time was 45 (30-75) minutes. In 17 (85%) patients, the defect was repaired with an omental patch, and in 3 (15%) patients with a falciform patch. The mean hospital stay was 3.5 (2-5) days.
Conclusion
Surgical techniques to be applied in treating peptic ulcer perforation are various, and the most preferred method is omental patch repair by laparotomy. In addition, Helicobacter pylori eradication treatment and control should be performed to prevent recurrence of perforation.

References

  • 1. Lanas A, Chan FKL: Peptic ulcer disease. Lancet. 2017, 390:613-24. 10.1016/S0140-6736(16)32404-7
  • 2. Zelickson MS, Bronder CM, Johnson BL, Camunas JA, Smith DE,Rawlinson D, Von S, Stone HH, Taylor SM. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. AmSurg 2011; 77: 1054-1060 [PMID: 21944523]
  • 3. Hernández-Díaz S, Rodríguez LA. Association between non steroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the1990s. Arch Intern Med 2000; 160: 2093-2099 Doi: 10.1001/archinte. 160.14.2093
  • 4. Chung KT, Shelat VG. Perforated peptic ulcer - an update. World J Gastrointest Surg. 2017;9(1):1-12. doi:10.4240/wjgs.v9.i1.1
  • 5. Kitagawa Y, Dempsey DT. Stomach. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e. McGraw Hill; 2015.
  • 6. Saverio S, Bassi M, Smerieri N, et al. “Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper.” World Journal of Emergency Surgery : WJES 9 (2014): 45 – 45
  • 7. Kim HC, Yang DM, Kim SW, Park SJ: Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time. Eur Radiol. 2014, 24:1386-93. 10.1007/s00330-014-3115-z
  • 8. Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, Søreide JA. Perforated peptic ulcer. Lancet. 2015 Sep 26;386(10000):1288-1298. doi: 10.1016/S0140- 6736(15)00276-7.
  • 9. Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013 Apr 10;21:25. doi: 10.1186/1757-7241-21-25
  • 10. Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987; 205: 22-26 [PMID: 3800459 DOI: 10.1097/00 000658-198701000-00005]
  • 11. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518-26.
  • 12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004 Aug 1;240(2):205-13.
  • 13. Tas I, Ulger BV, Onder A, Kapan M, Bozdag Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg. 2015;31(1):20–5.
  • 14. Dadfar A, Edna TH. Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. World J Gastroenterol. 2020 Sep 21;26(35):5302-5313.
  • 15. Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg. 2015;10(1):7–13.
  • 16. Koc M, Yoldas O, Kılıc Y, Gocmen E, Ertan T, Dizen H, et al. Comparison and validation of scoring systems in a cohort of patients treated for perforated peptic ulcer. Langenbecks Arch Surg. 2007;392(5):581–5.
  • 17. Ölmez A, Çiçek E, Aydın C, Kaplan K, Kayaalp C. Omentopexy versus falciformopexy for peptic ulcer perforation. Ulus Travma Acil Cerrahi Derg. 2019 Nov;25(6):580-584.
  • 18. Kwan JR, Lim M, Ng F, Shelat V. Fungal Isolates in Peritoneal Fluid Culture Do Not Impact Peri-Operative Outcomes of Peptic Ulcer Perforation. Surg Infect (Larchmt). 2019 Dec;20(8):619-624.
  • 19. Huston JM, Kreiner L, Ho VP, Sanders JM, Duane TM. Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions. Surg Infect (Larchmt). 2019 Dec;20(8):593-600.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Articles
Authors

Ahmet Cem Esmer 0000-0001-8279-186X

Hilmi Yazici 0000-0001-7470-0518

Publication Date October 15, 2022
Submission Date June 18, 2022
Acceptance Date August 3, 2022
Published in Issue Year 2022

Cite

AMA Esmer AC, Yazici H. Peptik Ülser Perforasyonu Nedeniyle Opere Edilen Hastaların Retrospektif Analizi: Tek Merkez Sonuçları. Acta Med Nicomedia. October 2022;5(3):188-192. doi:10.53446/actamednicomedia.1132705

images?q=tbn:ANd9GcSZGi2xIvqKAAwnJ5TSwN7g4cYXkrLAiHoAURHIjzbYqI5bffXt&s

"Acta Medica Nicomedia" Tıp dergisinde https://dergipark.org.tr/tr/pub/actamednicomedia adresinden yayımlanan makaleler açık erişime sahip olup Creative Commons Atıf-AynıLisanslaPaylaş 4.0 Uluslararası Lisansı (CC BY SA 4.0) ile lisanslanmıştır.