PMID- 26649091
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20151209
LR  - 20200930
IS  - 1895-4588 (Print)
IS  - 2299-0054 (Electronic)
IS  - 1895-4588 (Linking)
VI  - 10
IP  - 3
DP  - 2015 Sep
TI  - Changing patterns in the surgical treatment of perforated duodenal ulcer - single 
      centre experience.
PG  - 430-6
LID - 10.5114/wiitm.2015.54057 [doi]
AB  - INTRODUCTION: Although the surgical treatment of patients with perforated 
      duodenal ulcer is the method of choice, the introduction of effective 
      pharmacotherapy has changed the surgical strategy. Nowadays less extensive 
      procedures are chosen more frequently. The introduction of laparoscopic 
      procedures had a significant impact on treatment results. AIM: To present our 
      experience in the treatment of perforated duodenal ulcer in two periods, by 
      comparing open radical anti-ulcer procedures with laparoscopic ulcer repair. 
      MATERIAL AND METHODS: The analysis covered patients operated on for perforated 
      duodenal ulcer. Two groups of patients were compared. Group 1 included 245 
      patients operated on in the period 1980-1994 with a traditional method 
      (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). 
      Group 2 included 106 patients treated in the period 2000-2014 with the 
      laparoscopic technique supplemented with PPI therapy. Groups were compared in 
      terms of patients' demographic structure, operative time, complication rate and 
      mortality. RESULTS: The mean operative time in group 1 was shorter than in group 
      2 (p < 0.0001). Complications were noted in 57 (23.3%) patients in group 1 and 14 
      (13.5%) patients in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) 
      cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in 
      group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In 
      group 1, median length of hospital stay was 9 days and differed significantly 
      from group 2 (6 days, p < 0.0001). CONCLUSIONS: Within the last 30 years, 
      significant changes in treatment of perforated peptic ulcer (PPU) have occurred, 
      mainly related to abandoning routine radical anti-ulcer procedures and replacing 
      the open technique with minimally invasive surgery. Thus it was possible to 
      improve treatment results by reducing complication and mortality rates, and 
      shortening the length of hospital stay. Although the laparoscopic operation is 
      longer, it improves outcomes. In the authors' opinion, in each patient with 
      suspected peptic ulcer perforation, laparoscopy should be the method of choice.
FAU - Budzynski, Piotr
AU  - Budzynski P
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Pedziwiatr, Michal
AU  - Pedziwiatr M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Grzesiak-Kuik, Agata
AU  - Grzesiak-Kuik A
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Natkaniec, Michal
AU  - Natkaniec M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Major, Piotr
AU  - Major P
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Matlok, Maciej
AU  - Matlok M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Stanek, Maciej
AU  - Stanek M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Wierdak, Mateusz
AU  - Wierdak M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Migaczewski, Marcin
AU  - Migaczewski M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Pisarska, Magdalena
AU  - Pisarska M
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Budzynski, Andrzej
AU  - Budzynski A
AD  - 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, 
      Poland.
LA  - eng
PT  - Journal Article
DEP - 20150911
PL  - Poland
TA  - Wideochir Inne Tech Maloinwazyjne
JT  - Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other 
      miniinvasive techniques
JID - 101283175
PMC - PMC4653256
OTO - NOTNLM
OT  - duodenal ulcer
OT  - laparoscopic ulcer repair
OT  - laparoscopy
OT  - perforated peptic ulcer
EDAT- 2015/12/10 06:00
MHDA- 2015/12/10 06:01
PMCR- 2015/09/01
CRDT- 2015/12/10 06:00
PHST- 2015/02/26 00:00 [received]
PHST- 2015/03/18 00:00 [revised]
PHST- 2015/04/08 00:00 [accepted]
PHST- 2015/12/10 06:00 [entrez]
PHST- 2015/12/10 06:00 [pubmed]
PHST- 2015/12/10 06:01 [medline]
PHST- 2015/09/01 00:00 [pmc-release]
AID - 25733 [pii]
AID - 10.5114/wiitm.2015.54057 [doi]
PST - ppublish
SO  - Wideochir Inne Tech Maloinwazyjne. 2015 Sep;10(3):430-6. doi: 
      10.5114/wiitm.2015.54057. Epub 2015 Sep 11.