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Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors

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Abstract

Purpose

We evaluated the short-term and long-term outcomes of emergency operations for peptic ulcer (PUD) complications in a period of time in which the need for surgery is infrequent.

Methods

Retrospective review of operated patients (2007–2015) in one medical center.

Results

81 patients were included (8.9 patients/year): 70 (86.4%) male; 11 (13.6%) female. Indications for operation were hemorrhage in 18 (22.2%), perforation in 62 (76.5%) and gastric-outlet obstruction in one (1.2%). Only 16 (19.8%) operations included a procedure to reduce gastric acid secretion. Six (7.4%) patients had a second operation for recurrent or persistent complication. Of these, two had a procedure to reduce gastric acid secretion in their first operation. 16 (19.8%) patients died during the index hospitalization. Three (3.7%) patients were rehospitalized for a PUD complication following 3–24 months. One patient, who had surgery for a second perforation 3 months following the first operation, was treated empirically for Helicobacter Pylori (HP) between the two operations. In comparison to perforation, patients with hemorrhage were older (69.9 ± 20.3 vs. 52.1 ± 19.9 years; p = 0.0015), more commonly had a history of PUD or treatment by nonsteroidal anti-inflammotry drugs (55.6 vs. 19.4%; p = 0.0054), more commonly had a procedure to reduce gastric acid secretion during their index operation (61.1 vs. 6.5%; p < 0.0001), and had a higher mortality (38.9 vs. 14.5%; p = 0.0406).

Conclusions

Mortality is high following surgery for the complications of PUD, moreso in patients undergoing surgery for hemorrhage. Reoperations and repeated hospitalizations for complications are not uncommon, even in patients who have had procedures to reduce gastric acid secretion and HP eradication.

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Authors and Affiliations

  1. Hillel Yaffe Medical Center, POB 169, 38100, Hadera, Israel

    Rabea Hasadia, Yael Kopelman, Ricardo Alfici & Itamar Ashkenazi

  2. Shaare Zedek Medical Center, Jerusalem, Israel

    Oded Olsha

Authors
  1. Rabea Hasadia
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  2. Yael Kopelman
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  3. Oded Olsha
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  4. Ricardo Alfici
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  5. Itamar Ashkenazi
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Corresponding author

Correspondence to Itamar Ashkenazi.

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Conflict of interest

Rabea Hasadia, Yael Kopelman, Oded Olsha, Ricardo Aflici and Itamar Ashkenazi declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards. This article does not contain any studies with animals performed by any of the authors.

Ethical approval

This study was performed following approval of the Hillel Yaffe Medical Center’s institutional review board (Helsinki Committee).

Informed consent

This was a retrospective study and formal informed consent was not required.

Additional information

Preliminary results of this study were presented in the following conferences: 18th European Congress of Trauma and Emergency Surgery, Bucharest, Romania (May 7–9, 2017); 32nd Bi-annual meeting for the Israeli Surgical Association. Hotel Pastoral, Kfar Blum, Israel (May 10–12, 2017).

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Hasadia, R., Kopelman, Y., Olsha, O. et al. Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors. Eur J Trauma Emerg Surg 44, 795–801 (2018). https://doi.org/10.1007/s00068-017-0898-z

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  • DOI: https://doi.org/10.1007/s00068-017-0898-z

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