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Alatawi YF, Alhablani MA, Al-Rashidi FA, Khubrani WS, Alqaisi SA, Hassan HM, Al-Gayyar MM. Garcinol-Attenuated Gastric Ulcer (GU) Experimentally Induced in Rats Via Affecting Inflammation, Cell Proliferation, and DNA Polymerization. Cureus 2023; 15:e43317. [PMID: 37577271 PMCID: PMC10415854 DOI: 10.7759/cureus.43317] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Gastric ulcer (GU) is one of the most critical gastrointestinal tract disorders. Garcinol is a polyisoprenylated benzophenone in Garcinia fruit with antioxidant and anti-inflammatory priorities. OBJECTIVES We aimed to assess the protective effects of garcinol against GU induced in rats. We investigated garcinol's effects on DNA polymerization via mammalian targets of rapamycin (mTOR) and cyclin D1, cell proliferation via proliferating cell nuclear antigen (PCNA), inflammatory pathway via cyclooxygenase-2 (COX2), TNF-α, and IL-1β, and anti-inflammatory pathway via IL-4 and IL10. METHODS In our study, we administered a single oral dose of 80 mg/kg of indomethacin to rats to induce GU. Some of the rats were given a treatment of 50 mg/kg of garcinol. We examined the expressions of mTOR, cyclin D1, PCNA, COX2, TNF-α, and IL-1β/4/10 in the gastric tissues. Furthermore, we stained sections of the gastric tissues with Masson trichrome. RESULTS The areas of gastric tissues in the GU group showed severe hemorrhage and extensive fibrosis. Treating GU rats with garcinol prevented bleeding and ameliorated the fibrosis caused in gastric cells by GU. Moreover, treatment with garcinol significantly decreased the expression of mTOR, cyclin D1, PCNA, COX2, TNF-α, and IL-1β associated with elevation of IL-4 and IL-10. CONCLUSION Garcinol has been found to provide therapeutic benefits in rats with induced GU. These benefits may be due to its ability to decrease the expression of DNA polymerization markers, cell proliferation markers, and inflammatory markers at the gene and protein levels.
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Affiliation(s)
| | | | | | | | | | - Hanan M Hassan
- Pharmacology and Biochemistry, Delta University for Science and Technology, Gamasa, EGY
| | - Mohammed M Al-Gayyar
- Pharmaceutical Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk, SAU
- Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura, EGY
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Idris M, Smiley A, Patel S, Latifi R. Risk Factors for Mortality in Emergently Admitted Patients with Acute Gastric Ulcer: An Analysis of 15,538 Patients in National Inpatient Sample, 2005-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16263. [PMID: 36498337 PMCID: PMC9736004 DOI: 10.3390/ijerph192316263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Background: Patients admitted emergently with a primary diagnosis of acute gastric ulcer have significant complications including morbidity and mortality. The objective of this study was to assess the risk factors of mortality including the role of surgery in gastric ulcers. Methods: Adult (18−64-year-old) and elderly (≥65-year-old) patients admitted emergently with hemorrhagic and/or perforated gastric ulcers, were analyzed using the National Inpatient Sample database, 2005−2014. Demographics, various clinical data, and associated comorbidities were collected. A stratified analysis was combined with a multivariable logistic regression model to assess predictors of mortality. Results: Our study analyzed a total of 15,538 patients, split independently into two age groups: 6338 adult patients and 9200 elderly patients. The mean age (SD) was 50.42 (10.65) in adult males vs. 51.10 (10.35) in adult females (p < 0.05). The mean age (SD) was 76.72 (7.50) in elderly males vs. 79.03 (7.80) in elderly females (p < 0.001). The percentage of total deceased adults was 1.9% and the percentage of total deceased elderly was 3.7%, a difference by a factor of 1.94. Out of 3283 adult patients who underwent surgery, 32.1% had perforated non-hemorrhagic ulcers vs. 1.8% in the non-surgical counterparts (p < 0.001). In the 4181 elderly surgical patients, 18.1% had perforated non-hemorrhagic ulcers vs. 1.2% in the non-surgical counterparts (p < 0.001). In adult patients managed surgically, 2.6% were deceased, while in elderly patients managed surgically, 5.5% were deceased. The mortality of non-surgical counterparts in both age groups were lower (p < 0.001). The multivariable logistic regression model for adult patients electing surgery found delayed surgery, frailty, and the presence of perforations to be the main risk factors for mortality. In the regression model for elderly surgical patients, delayed surgery, frailty, presence of perforations, the male sex, and age were the main risk factors for mortality. In contrast, the regression model for adult patients with no surgery found hospital length of stay to be the main risk factor for mortality, whereas invasive diagnostic procedures were protective. In elderly non-surgical patients, hospital length of stay, presence of perforations, age, and frailty were the main risk factors for mortality, while invasive diagnostic procedures were protective. The following comorbidities were associated with gastric ulcers: alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes, and renal failure. Conclusions: The odds of mortality in emergently admitted geriatric patients with acute gastric ulcer was two times that in adult patients. Surgery was a protective factor for patients admitted emergently with gastric perforated non-hemorrhagic ulcers.
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Affiliation(s)
- Maksat Idris
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Abbas Smiley
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Saral Patel
- New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, AZ 85721, USA
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Zhu C, Badach J, Lin A, Mathur N, McHugh S, Saracco B, Adams A, Gaughan J, Atabek U, Spitz FR, Hong YK. Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate. Am J Surg 2020; 221:935-941. [PMID: 32943177 DOI: 10.1016/j.amjsurg.2020.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature. METHODS A systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations. RESULTS The search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209. CONCLUSION In this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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Affiliation(s)
- Clara Zhu
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Jeremy Badach
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Andrew Lin
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Natasha Mathur
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Sean McHugh
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Benjamin Saracco
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - John Gaughan
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Umur Atabek
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Francis R Spitz
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Young K Hong
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States.
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Korotkevich AG, Yaroshchuk SA, Leontyev AS, May SA, Bersenev AA. Treatment of subhepatic abscess due to complicated perforation of gastric ulcer. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2020. [DOI: 10.31146/1682-8658-ecg-174-2-95-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Formation of abdominal abscesses with perforated ulcers of the stomach and duodenum with conservative treatment ranges from 3% to 14%. The main strategy for their treatment is a minimally invasive puncture treatment. A case of a patient’s late treatment of 56 years with a perforated giant gastric ulcer, the formation of a subhepatic abscess and its drainage into the lumen of the stomach is presented. Used methods of drainage of an abscess through a mini-access under the control of gastroscopy. A complex of therapeutic measures has been described, which allowed for the obliteration of an abscess cavity and the healing of a giant stomach ulcer within a month. It is concluded that the need for early use of gastroscopy in the differential diagnosis of perforated ulcers.
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Affiliation(s)
- A. G. Korotkevich
- Novokuznetsk State Institute for Further Training of Physicians — Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation; Novokuznetsk City Clinical Hospital № 29
| | | | - A. S. Leontyev
- Novokuznetsk State Institute for Further Training of Physicians — Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation; Novokuznetsk City Clinical Hospital № 29
| | - S. A. May
- Novokuznetsk City Clinical Hospital № 29
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Elrobaa IH, Khan AH, Ahmad MK, Elamatha AJ, Elserhy MD, Eltahir E, Saifeldeen KA. Huge hydro pneumoperitoneum reported as complication of perforated duodenal ulcer with interesting images. Pan Afr Med J 2020; 34:217. [PMID: 32180889 PMCID: PMC7060911 DOI: 10.11604/pamj.2019.34.217.20829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/03/2019] [Indexed: 11/11/2022] Open
Abstract
This case has interesting images of huge hydro pneumoperitoneum. It is a rare view in the medical practice and a good point to learn one of the complications of perforated duodenal ulcer and failure of omental patch operation. We reported a case of acute abdominal pain with hydro pneumoperitoneum that appeared as an air fluid line in X-ray. The patient had an omental patch surgery. Two days after the operation he got severe abdominal pain. The X-ray images showed significant huge hydro pneumoperitoneum. He underwent urgent surgical intervention for exploration that detected a large amount of gases, a biliary free fluid and a leak from duodenal ulcer. Omental buttressing was then performed.
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Affiliation(s)
| | | | | | | | | | - Elfatih Eltahir
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
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6
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Okidi R, Sambo VD, Ogwang MD, Mutiibwa D, Benitez NP, Bongomin F. Thirty-day postoperative outcome of patients with non-traumatic gastroduodenal perforations in southwestern Uganda. Trop Doct 2019; 50:15-19. [PMID: 31739759 DOI: 10.1177/0049475519887654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We studied our 30-day postoperative outcomes in patients with non-traumatic gastroduodenal perforation (NTGDP) in Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a one-year prospective study of patients who underwent exploratory laparotomy for suspected NTGDP between June 2016 and July 2017. Twenty-nine patients had NTGDP, the male-to-female ratio was 3:1 and median age was 60 years (range = 13-80 years). Most (83%) patients were negative for Helicobacter pylori on histology. One patient had a gastric adenocarcinoma. A total of 26 (90%) patients had Graham's omentopexy performed. The 30-day mortality rate was 34%. Pyrexia at hospital admission, pre-surgical delay (> 72 h), preoperative shock and peritoneal contamination, were associated with higher mortality rates with preoperative shock being an independent predictor of mortality. H. pylori-negative NTGDP presents a unique challenge in our setting, affecting mainly middle-aged and elderly patients. One-third of our patients did not survive one month.
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Affiliation(s)
- Ronald Okidi
- Department of Surgery, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Vanusa D Sambo
- Department of Surgery, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Martin D Ogwang
- Department of Surgery, St. Mary's Hospital Lacor, Gulu, Uganda
| | - David Mutiibwa
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Noralis P Benitez
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Gachabayov M, Babyshin V, Durymanov O, Neronov D. Surgical Scales: Primary Closure versus Gastric Resection for Perforated Gastric Ulcer - A Surgical Debate. Niger J Surg 2017; 23:1-4. [PMID: 28584503 PMCID: PMC5441208 DOI: 10.4103/1117-6806.199959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Perforated gastric ulcer is one of the most life-threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59-year-old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology-related factors influencing the decision-making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient- and healthcare-related factors should also be considered.
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Affiliation(s)
- Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Valentin Babyshin
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Oleg Durymanov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Dmitriy Neronov
- Department of ICU and Anaesthesiology, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
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8
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Leeman MF, Skouras C, Paterson-Brown S. The management of perforated gastric ulcers. Int J Surg 2013; 11:322-4. [PMID: 23454244 DOI: 10.1016/j.ijsu.2013.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Perforated gastric ulcers are potentially complicated surgical emergencies and appropriate early management is essential in order to avoid subsequent problems including unnecessary gastrectomy. The aim of this study was to examine the management and outcome of patients with gastric ulcer perforation undergoing emergency laparotomy for peritonitis. METHODS Patients undergoing laparotomy at the Royal Infirmary of Edinburgh for perforated gastric ulcers were identified from the prospectively maintained Lothian Surgical Audit (LSA) database over the five-year period 2007-2011. Additional data were obtained by review of electronic records and review of case notes. RESULTS Forty-four patients (25 male, 19 female) were identified. Procedures performed were: 41 omental patch repairs (91%), 2 simple closures (4.5%) and 2 distal gastrectomies (4.5%; both for large perforations). Four perforated gastric tumours were identified (8.8%), 2 of which were suspected intra-operatively and confirmed histologically, 1 had unexpected positive histology and 1 had negative intra-operative histology, but follow-up endoscopy confirmed the presence of carcinoma (1 positive biopsy in 21 follow-up endoscopies); all 4 were managed without initial resection. Median length of stay was 10 days (range 4-68). Overall 7 patients died in hospital (15.9%) and there were 21 morbidities (54.5%). Registrars performed the majority of the procedures (16 alone, 21 supervised) with no significant difference in post-operative morbidity (P = 0.098) or mortality (P = 0.855), compared to consultants. CONCLUSION Almost all perforated gastric ulcers can be effectively managed by laparotomy and omental patch repair. Initial biopsy and follow-up endoscopy with repeat biopsy is essential to avoid missing an underlying malignancy.
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Affiliation(s)
- Matthew Fraser Leeman
- Department of Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, United Kingdom.
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Domínguez-Vega G, Pera M, Ramón JM, Puig S, Membrilla E, Sancho J, Grande L. [A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers]. Cir Esp 2013; 91:372-7. [PMID: 23332653 DOI: 10.1016/j.ciresp.2012.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/10/2012] [Accepted: 10/14/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU). METHODS All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. RESULTS Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6h) compared to the open group (12h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5min vs. 76min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041). CONCLUSION Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group.
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Affiliation(s)
- Gerardo Domínguez-Vega
- Sección de Cirugía Gastrointestinal, Hospital Universitario del Mar, Institut Hospital del Mar d'Investigacions Mèdiques IMIM, Universitat Autònoma de Barcelona, Barcelona, España
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10
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Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, Moore FA, Velmahos G, Coimbra R, Ivatury R, Peitzman A, Koike K, Leppaniemi A, Biffl W, Burlew CC, Balogh ZJ, Boffard K, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Wani I, Escalona A, Ordonez C, Fraga GP, Junior GAP, Bala M, Cui Y, Marwah S, Sakakushev B, Kong V, Naidoo N, Ahmed A, Abbas A, Guercioni G, Vettoretto N, Díaz-Nieto R, Gerych I, Tranà C, Faro MP, Yuan KC, Kok KYY, Mefire AC, Lee JG, Hong SK, Ghnnam W, Siribumrungwong B, Sato N, Murata K, Irahara T, Coccolini F, Lohse HAS, Verni A, Shoko T. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 2013; 8:3. [PMID: 23294512 PMCID: PMC3545734 DOI: 10.1186/1749-7922-8-3] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 12/11/2022] Open
Abstract
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.
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Affiliation(s)
| | - Pierluigi Viale
- Clinic of Infectious Diseases, Department of Internal Medicine Geriatrics and Nephrologic Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
| | - Luca Ansaloni
- Department of General Surgery, Ospedali Riuniti, Bergamo, Italy
| | - Ernest Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | | | | | - George Velmahos
- Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston, MA, USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, CA, USA
| | - Rao Ivatury
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Andrew Peitzman
- Division of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kaoru Koike
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | - Walter Biffl
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | | | - Zsolt J Balogh
- Department of Surgery, University of Newcastle, Newcastle, NSW, Australia
| | - Ken Boffard
- Department of Surgery, Charlotte Maxeke Johannesburg Hospital University of the Witwatersrand, Johannesburg, South Africa
| | - Cino Bendinelli
- Department of Surgery, University of Newcastle, Newcastle, NSW, Australia
| | - Sanjay Gupta
- Department of Surgery, Govt Medical College and Hospital, Chandigarh, India
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Imtiaz Wani
- Department of Digestive Surgery Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Escalona
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Carlos Ordonez
- Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinicas - University of Campinas, Campinas, Brazil
| | | | - Miklosh Bala
- Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Sanjay Marwah
- Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital /UMBAL/ St George Plovdiv, Plovdiv, Bulgaria
| | - Victor Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa
| | - Noel Naidoo
- Department of Surgery, Port Shepstone Hospital, Kwazulu Natal, South Africa
| | - Adamu Ahmed
- Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria
| | - Ashraf Abbas
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | | | - Rafael Díaz-Nieto
- Department of General and Digestive Surgery, University Hospital, Malaga, Spain
| | - Ihor Gerych
- Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine
| | | | - Mario Paulo Faro
- Division of General and Emergency Surgery, Faculdade de Medicina da Fundação do ABC, São Paulo, Santo André, Brazil
| | - Kuo-Ching Yuan
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | - Jae Gil Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea
| | - Wagih Ghnnam
- Wagih Ghnnam, Department of Surgery, Khamis Mushayt General Hospital, Khamis Mushayt, Saudi Arabia
| | - Boonying Siribumrungwong
- Boonying Siribumrungwong, Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand
| | - Norio Sato
- Division of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kiyoshi Murata
- Department of Acute and Critical Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan
| | | | | | - Alfredo Verni
- Department of Surgery, Cutral Co Clinic, Neuquen, Argentina
| | - Tomohisa Shoko
- The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan
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11
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers. World J Surg 2012; 35:2485-92. [PMID: 21915743 DOI: 10.1007/s00268-011-1252-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several studies have advocated laparoscopic simple closure (LSC) as the treatment of choice for perforated peptic ulcer disease (PUD). However, there has been no comprehensive community-based evaluation of the advantages of using LSC over open simple closure (OSC). Using an administrative database, we evaluated LSC versus OSC for patients with perforated ulcers. METHODS From 6,334 patients with perforated ulcers, we identified 2,909 simple closure cases between 2006 and 2010. Study variables were demographics, mortality, co-morbidities, complications, ulcer location, surgical timing, blood transfusion, postoperative ventilation, operating room (OR) time, time to resumption of oral food intake, length of stay (LOS), and total charges. After matching patient baseline variables between OSC and LSC, we performed multivariate analyses to assess the impacts of LSC on mortality, complications, and ventilation administration. RESULTS A total of 2,073 OSC cases and 836 LSC cases were identified in 670 hospitals. Younger age, duodenal ulcer, and pre-existing PUD were indicators for selection of LSC. Matching analysis indicated a correlation between LSC and lower mortality, less frequent postoperative and overall blood transfusion, shorter LOS, earlier return to oral intake, and longer OR time. There was no difference between OSC and LSC in complication rate or mortality. Longer OR time was correlated with a higher complication rate and the need for ventilation, the latter of which was independently associated with an increase in mortality. CONCLUSIONS Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly.
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Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
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MØLLER MH, ENGEBJERG MC, ADAMSEN S, BENDIX J, THOMSEN RW. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand 2012; 56:655-62. [PMID: 22191386 DOI: 10.1111/j.1399-6576.2011.02609.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Accurate and early identification of high-risk surgical patients with perforated peptic ulcer (PPU) is important for triage and risk stratification. The objective of the present study was to develop a new and improved clinical rule to predict mortality in patients following surgical treatment for PPU. METHODS DESIGN nationwide cohort study based on prospectively collected data. SETTING thirty-five hospitals in Denmark. PATIENTS a total of 2668 patients surgically treated for gastric or duodenal PPU between 1 February 2003 and 31 August 2009. OUTCOME MEASURE 30-day mortality. RESULTS We derived a new clinical prediction rule for 30-day mortality and evaluated and compared its prognostic performance with the American Society of Anaesthesiologists (ASA) and Boey scores. A total of 708 patients (27%) died within 30 days of surgery. The Peptic Ulcer Perforation (PULP) score - comprised eight variables with an adjusted odds ratio of more than 1.28: 1) age > 65 years, 2) active malignant disease or AIDS, 3) liver cirrhosis, 4) steroid use, 5) time from perforation to admission > 24 h, 6) pre-operative shock, 7) serum creatinine > 130 μM, and 8) the four levels of the ASA score (from 2 to 5). The score predicted mortality well (area under receiver operating characteristics curve (AUC) 0.83). It performed considerably better than the Boey score (AUC 0.70) and better than the ASA score alone (AUC 0.78). CONCLUSION The PULP score accurately predicts 30-day mortality in patients operated for PPU and can assist in risk stratification and triage.
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Affiliation(s)
- M. H. MØLLER
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital Bispebjerg; Copenhagen; Denmark
| | - M. C. ENGEBJERG
- Department of Clinical Epidemiology; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus; Denmark
| | - S. ADAMSEN
- Department of Gastrointestinal Surgery; Copenhagen University Hospital Herlev; Herlev; Denmark
| | - J. BENDIX
- Department of Gastrointestinal Surgery; Aarhus University Hospital; Aarhus; Denmark
| | - R. W. THOMSEN
- Department of Clinical Epidemiology; Institute of Clinical Medicine; Aarhus University Hospital; Aarhus; Denmark
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Abstract
The usefulness of the minilaparotomy approach for perforated duodenal ulcer repair was retrospectively evaluated in 37 patients (26 men; mean age, 56.5 years). Simple closure with an omental patch by minilaparotomy (skin incision, < or = 7 cm) was successful in 86.5% of the cases, with an operative mortality of 2.7%. Compared with the results in historic control patients who underwent conventional open surgery (n = 27), a shorter operative time (P < 0.01), lower frequency of analgesic use (P = 0.03), earlier passage of flatus (P < 0.01), and shorter hospital stay (P = 0.04) were obtained in the patients undergoing minilapartomoy. The postoperative morbidity was identical between the two groups (16.2% versus 33.3%, P = 0.40). On multivariate analysis, a large amount of intraabdominal fluid was the only significant risk factor for extension of the minilaparotomy wound (P = 0.012). The minilaparotomy approach appears to be a feasible, safe, and less invasive approach compared with the conventional open approach and could be a useful alternative to the laparoscopic approach in selected patients with perforated duodenal ulcer.
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Buck DL, Vester-Andersen M, Møller MH. Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study. Scand J Gastroenterol 2012; 47:28-35. [PMID: 22126610 DOI: 10.3109/00365521.2011.639078] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the ability of four clinical prediction rules to predict adverse outcome in perforated peptic ulcer (PPU): the Boey score, the American Society of Anesthesiologists (ASA) score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the sepsis score. DESIGN an observational multicenter study. PARTICIPANTS AND SETTINGS a total of 117 patients surgically treated for PPU between 1 January 2008 and 31 December 2009 in seven gastrointestinal departments in Denmark were included. Pregnant and breastfeeding women, non-surgically treated patients, patients with malignant ulcers, and patients with perforation of other organs were excluded. PRIMARY OUTCOME MEASURE 30-day mortality rate. STATISTICAL ANALYSIS the ability of four clinical prediction rules to distinguish survivors from non-survivors (discrimination ability) was evaluated by the area under the receiver operating characteristic curve (AUC), positive predictive values (PPVs), negative predictive values (NPVs), and adjusted relative risks. RESULTS Median age (range) was 70 years (25-92 years), 51% of the patients were females, and 73% of the patients had at least one co-existing disease. The 30-day mortality proportion was 17% (20/117). The AUCs: the Boey score, 0.63; the sepsis score, 0.69; the ASA score, 0.73; and the APACHE II score, 0.76. Overall, the PPVs of all four prediction rules were low and the NPVs high. CONCLUSIONS The Boey score, the ASA score, the APACHE II score, and the sepsis score predict mortality poorly in patients with PPU.
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Reappraising the surgical approach on the perforated gastroduodenal ulcer: should gastric resection be abandoned? J Clin Med Res 2011; 3:213-22. [PMID: 22383908 PMCID: PMC3279482 DOI: 10.4021/jocmr608w] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2011] [Indexed: 12/12/2022] Open
Abstract
Background Advancements in medical care for peptic ulcer disease (PUD) have reduced the need for invasive surgical procedures such as gastric resection (GR). Community-based PUD studies from a large sampling of PUD patients designed to analyze hospital resource use and outcomes after different surgical procedures have been rare. We aimed to exhaustively reappraise the risk factors and patient demographics that affect PUD patient recoveries after GR compared to those after simple closure (SC). Methods We used a Japanese administrative database for 6 consecutive months each year between 2006 and 2010. The database included a total of 68,432 PUD patients; we analyzed 6,334 perforation cases and 3,148 cases of patients who underwent GR or SC. Study variables were demographics, comorbidities, characteristics of PUD, and operative day. Study outcomes that were analyzed included mortality, postoperative complications, ventilation administration, postoperative blood transfusions, length of stay, total charges, operating room (OR) time, and the postoperative fasting period (defined as the day of surgery to the day oral food intake was resumed.) To reduce selection bias in study procedures and to control the variation in hospital practice, a propensity score (PS) matching cohort analysis and a mixed linear regression model were used to assess the effects of GR on the outcomes. Results In 699 hospitals, 322 GRs and 2,826 SCs were observed. Younger age, duodenal ulcers, preexisting anemia and an operative day no more than 24hours were significant associated with the choice of SCs. No significant differences were observed in study outcomes after either GR or SC; more postoperative blood transfusions and longer OR times but shorter postoperative fasting periods were observed after GR. Longer OR times, ventilation and postoperative blood transfusion were significantly associated with mortality. Not GR but longer OR times use of ventilation and complications were the most significant indicators of increased resource use. Conclusions There were no major significant differences in GR when compared to SC with regards to patient recoveries. Surgeons should obtain the skills and establish strategies to optimize either type of surgical procedure including minimizing OR time and establishing the best perioperative critical care. Keywords Peptic ulcer perforation; Simple closure; Gastric resection; Outcome; Resource use
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Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Sartelli M, Viale P, Koike K, Pea F, Tumietto F, van Goor H, Guercioni G, Nespoli A, Tranà C, Catena F, Ansaloni L, Leppaniemi A, Biffl W, Moore FA, Poggetti R, Pinna AD, Moore EE. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections. World J Emerg Surg 2011; 6:2. [PMID: 21232143 PMCID: PMC3031281 DOI: 10.1186/1749-7922-6-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 01/13/2011] [Indexed: 12/11/2022] Open
Abstract
Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.
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Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol 2010; 45:785-805. [PMID: 20384526 DOI: 10.3109/00365521003783320] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Mortality and morbidity following perforated peptic ulcer (PPU) is substantial and probably related to the development of sepsis. During the last three decades a large number of preoperative prognostic factors in patients with PPU have been examined. The aim of this systematic review was to summarize available evidence on these prognostic factors. MATERIAL AND METHODS MEDLINE (January 1966 to June 2009), EMBASE (January 1980 to June 2009), and the Cochrane Library (Issue 3, 2009) were screened for studies reporting preoperative prognostic factors for mortality in patients with PPU. The methodological quality of the included studies was assessed. Summary relative risks with 95% confidence intervals for the identified prognostic factors were calculated and presented as Forest plots. RESULTS Fifty prognostic studies with 37 prognostic factors comprising a total of 29,782 patients were included in the review. The overall methodological quality was acceptable, yet only two-thirds of the studies provided confounder adjusted estimates. The studies provided strong evidence for an association of older age, comorbidity, and use of NSAIDs or steroids with mortality. Shock upon admission, preoperative metabolic acidosis, tachycardia, acute renal failure, low serum albumin level, high American Society of Anaesthesiologists score, and preoperative delay >24 h were associated with poor prognosis. CONCLUSIONS In patients with PPU, a number of negative prognostic factors can be identified prior to surgery, and many of these seem to be related to presence of the sepsis syndrome.
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Affiliation(s)
- Morten Hylander Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Denmark.
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