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Abouelazayem M, Jain R, Wilson MSJ, Martinino A, Balasubaramaniam V, Biffl W, Coccolini F, Riera M, Wadhawan H, Wazir I, Abderaouf B, Abramov D, Abu Jayyab MA, Al-Shami K, Alfarwan A, Alhajami FM, Alkaseek A, Alozairi O, Ammar AS, Atar B, Baatarjav GE, Bains L, Bakri A, Bayramov N, Bhojwani R, Brachini G, Calini G, Campanelli M, Cheng SY, Choudhary CS, Chowdhury S, Colak E, Das JK, Dawani S, Dönmez T, Elzayat I, Erdene S, Faizi TQ, Frountzas M, Gafsi B, Gentileschi P, Guler M, Gupta G, Harkati NE, Harris M, Hasan DM, Irowa OO, Jafferi S, Jain SA, Jun Han L, Kandiboyina SM, Karabulut M, Khamees A, Khan S, Khan MM, Khaw CJ, Kisielewski M, Klib M, Košir JA, Krawczyk WJ, Lisi G, Makama JG, Maqbool B, Marques CN, Meric S, Mietła MP, Ads AM, Muhumuza J, Mulita F, Mustafayeva M, Omar MA, Omarov T, Pathak AA, Paul R, Pavone G, Podda M, Raja Ram NK, Rauf F, Rauf S, Safy AM, Sandag E, Şanlı AN, Siddiqui AZ, Sotiropoulou M, Talib V, Tatar C, Thota A, Tokocin M, Tolat A, Uchikov PA, Valenzuela JI, Venkatappa SK, Verras GI, Vlahović I, Zreeg DAS, Cardoso VR, Gkoutos GV, Singhal R, Mahawar K. Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study. Surg Endosc 2024:10.1007/s00464-024-10881-0. [PMID: 38886232 DOI: 10.1007/s00464-024-10881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.
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Affiliation(s)
- Mohamed Abouelazayem
- Department of Surgery, University College London Hospitals, London, UK.
- Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt.
- , General Surgery, University College Hospital, UCLH Contact Centre, Ground Floor North, 250 Euston Road, London, NW1 2PG, UK.
| | - Rajesh Jain
- Shrewsbury & Telford Hospital NHS Trust, Shrewsbury, UK
| | | | | | | | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Himanshu Wadhawan
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | | | | | - Daniil Abramov
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | | | | | | | | | | | | | | | - Burak Atar
- Bakırköy Training and Research Hostpital, Bakirkoy, Turkey
| | | | | | | | | | | | - Gioia Brachini
- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giacomo Calini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michela Campanelli
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | - Turgut Dönmez
- Bakırköy Training and Research Hospital, Bakirkoy, Turkey
| | | | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, Athens, Greece
| | - Besma Gafsi
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Mert Guler
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Salman Jafferi
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | | | | | | | | | | | - Shahzeb Khan
- MTI Khyber Teaching Hospital, Peshawar, Pakistan
| | | | | | | | | | | | - Wiktor Jan Krawczyk
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome, Italy
| | | | | | | | - Serhat Meric
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mateusz Przemysław Mietła
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Matanat Mustafayeva
- Scientific Center of Surgery After Named M.A.Topchubashov, Azerbaijan, Azerbaijan
| | - Mohammed A Omar
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | | | | | | | | | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fatima Rauf
- Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Sidra Rauf
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Ahmed Mohamed Safy
- General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Erdene Sandag
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Vikash Talib
- Jinnah Postgraduate and Medical Center, Karachi, Pakistan
| | - Cihad Tatar
- Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Anuroop Thota
- NRI Medical College, General & Superspeciality Hospital, Chinakakani, India
| | - Merve Tokocin
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Ivan Vlahović
- Department of Surgery, Clinical Hospital Center Osijek, University of Osijek, Osijek, Croatia
| | | | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Health Data Science, University of Birmingham, Birmingham, UK
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, University of Sunderland, Sunderland, UK
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Costa G, Garbarino GM, Lepre L, Liotta G, Mazzoni G, Gabrieli A, Costa A, Podda M, Sganga G, Fransvea P. Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture. J Clin Med 2024; 13:1242. [PMID: 38592114 PMCID: PMC10931710 DOI: 10.3390/jcm13051242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Peptic ulcers result from imbalanced acid production, and in recent decades, proton pump inhibitors have proven effective in treating them. However, perforated peptic ulcers (PPU) continue to occur with a persistent high mortality rate when not managed properly. The advantages of the laparoscopic approach have been widely acknowledged. Nevertheless, concerning certain technical aspects of this method, such as the best gastrorrhaphy technique, the consensus remains elusive. Consequently, the choice tends to rely on individual surgical experiences. Our study aimed to compare interrupted stitches versus running barbed suture for laparoscopic PPU repair. Methods: We conducted a retrospective study utilizing propensity score matching analysis on patients who underwent laparoscopic PPU repair. Patients were categorised into two groups: Interrupted Stitches Suture (IStiS) and Knotless Suture (KnotS). We then compared the clinical and pathological characteristics of patients in both groups. Results: A total of 265 patients underwent laparoscopic PPU repair: 198 patients with interrupted stitches technique and 67 with barbed knotless suture. Following propensity score matching, each group (IStiS and KnotS) comprised 56 patients. The analysis revealed that operative time did not differ between groups: 87.9 ± 39.7 vs. 92.8 ± 42.6 min (p = 0.537). Postoperative morbidity (24.0% vs. 32.7%, p = 0.331) and Clavien-Dindo III (10.7% vs. 5.4%, p = 0.489) were more frequently observed in the KnotS group, without any significant difference. In contrast, we found a slightly higher mortality rate in the IStiS group (10.7% vs. 7.1%, p = 0.742). Concerning leaks, no differences emerged between groups (3.6% vs. 5.4%, p = 1.000). Conclusions: Laparoscopic PPU repair with knotless barbed sutures is a non-inferior alternative to interrupted stitches repair. Nevertheless, further research such as randomised trials, with a standardised treatment protocol according to ulcer size, are required to identify the best gastrorraphy technique.
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Affiliation(s)
- Gianluca Costa
- Surgery Center, Colorectal Surgery Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | | | - Luca Lepre
- General and Emergency Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, 00193 Rome, Italy;
| | - Gianluca Liotta
- General and Emergency Surgery Unit, Palestrina Hospital, ASL Roma 6, 00036 Palestrina, Italy
| | - Gianluca Mazzoni
- General Surgery Unit, G.B. Grassi Hospital, ASL Roma 3, 00122 Rome, Italy
| | - Alice Gabrieli
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy;
| | - Alessandro Costa
- UniCamillus School of Medicine, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00135 Rome, Italy (P.F.)
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00135 Rome, Italy (P.F.)
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Ciuntu BM, Tanevski A, Buescu DO, Lutenco V, Mihailov R, Ciuntu MS, Zuzu MM, Vintila D, Zabara M, Trofin A, Cadar R, Nastase A, Lupascu Ursulescu C, Lupascu CD. Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations. J Clin Med 2024; 13:470. [PMID: 38256604 PMCID: PMC10816729 DOI: 10.3390/jcm13020470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.
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Affiliation(s)
- Bogdan Mihnea Ciuntu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Adelina Tanevski
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - David Ovidiu Buescu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Valerii Lutenco
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Raul Mihailov
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Madalina Stefana Ciuntu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Mihai Marius Zuzu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Dan Vintila
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Mihai Zabara
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Trofin
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ramona Cadar
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Nastase
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cristian Dumitru Lupascu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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