Abstract
Despite changes in management and the advances in therapeutics, surgeons are still required to treat the complications of peptic ulceration. A retrospective review of all open surgical interventions for complications of peptic ulcer disease between January 1983 and December 1993 was carried out. There were no exclusion criteria.
Open gastric surgery accounted for 3% of all inpatient surgical procedures and 13% of all the major operations. There were 341 adult and 132 paediatric procedures performed in the 11 year period. Acute gastric procedures accounted for 34% of major gastric surgery in this district unit. 76 perforated ulcers and 39 bleeding ulcers required surgery. 38% of the patients were over 70 years.
The perioperative mortality was 13.9% (4% for those under 70 years). The overall morbidity rate was 71% and procedure-related morbidity rate was 17%. Acute gastric surgery has a very high inpatient morbidity and is associated with a significant mortality particularly in elderly patients.
Similar content being viewed by others
References
Fineberg, H. V., Pearlman, L. A. Surgical treatment of peptic ulcer United States. Lancet 1981; i: 1305–1307.
Christensen, A., Bousfield, R., Christiansen, J. Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2-receptor antagonists. Ann Surg. 1988; 207: 46.
Holman, R. A. E., David, M., Gough, K. R., Gartell, P., Britton, D. C., Smith, R. B. Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital. Gut 1990; 31: 504–8.
Wheatley, K. E., Snyman, J. H., Brearly, S., Keighley, M. R. B., Dykes, P. W. Mortality in patients with bleeding peptic ulcer when those aged 60 or over are operated on early. Br. Med. J. 1990; 301: 272.
Poxon, V. A., Keighley, M. R. B., Dykes, P. W., Heppinstall, K., Jaderberg, M. Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial. Br. J. Surg. 1991; 78: 344–45.
Walt, R., Katschinski, B., Logan, R., Ashley, J., Langman, M. Rising frequency of ulcer perforation in elderly people in the United Kingdom. Lancet 1986; i: 489–92.
Jordan, P. H., Morrow, C. Perforated peptic ulcer. Surg. Clin. Nth. Am. 1988; 68: 315–29.
Matthewson, K., Pugh, S., Northfield, T. C. Which peptic ulcer patients bleed? Gut 1988; 29: 70–4.
Fleischer, D. Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology 1983; 84: 538–43.
Rogers, P. N., Murray, W. R., Shaw, R., Brar, S. Surgical management of bleeding gastric ulceration. Br. J. Surg. 1988; 75: 16–17.
Hunt, P. S., Hansky, J., Korman, M. G. Mortality in patients with haematemesis and melaena: a prospective study. Br. Med. J. 1979; 1 1238–40.
Park, K. G. M., Steele, R. J. C., Mollison, J., Crofts, T. J. Prediction of recurrent bleeding after endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage. Br. J. Surg. 1994; 81: 1465–8.
Tekant, Y., Goh, P., Alexander, D. J., Isaac, J. R., Kum, C. K., Ngoi, S. S. Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: a prospective randomized trial. Br. J. Surg. 1995; 82: 223–6.
Watkins, R. M., Dennison, A. R., Collin, J. What has happened to perforated peptic ulcer? Br. J. Surg. 1984; 71: 774–6.
Jorgensen, T. G. Drug consumption before perforation of peptic ulcer. Br. J. Surg. 1977; 64: 247–9.
Bornman, P. C., Theodorou, N. A., Jeffery, P. C., Marks, I. N., Essel, H. P., Wright, J. P., Terblanche, J. Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br. J. Surg. 1990; 77: 73–5.
Raimes, S. A., Devlin, H. B. Perforated duodenal ulcer. Br. J. Surg. 1987; 74: 81–2.
Boey, J., Lee, N. W., Koo, J., Lam, P. H. M., Wong, J., Ong, G. B. Immediate definitive surgery for perforated duodenal ulcers. A prospective controlled trial. Ann Surg. 1982; 196: 338–42.
Sebastian, M. Prem Chandran, V. P. Elashaal, Y. I. M. Sim, A. J. W.Helicobacter pylori infection in perforated peptic ulcer disease. Br. J. Surg. 1995; 82: 360–2.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Barry, M.C., Gul, Y., Davies, M.G. et al. Changing trends in acute peptic ulcer surgery in a district surgical unit. I.J.M.S. 165, 109–112 (1996). https://doi.org/10.1007/BF02943795
Issue Date:
DOI: https://doi.org/10.1007/BF02943795