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Treatment for Perforated Gastric Ulcer: a Multi-institutional Retrospective Review

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The optimal treatment for patients with perforated gastric ulcer (PGU) remains controversial. This study therefore investigated the treatment status for this disease in clinical practice.

Methods

We retrospectively reviewed 183 patients with PGU from 1998 to 2007 across 15 institutions, and analyzed patient characteristics and short- and long-term outcomes according to treatments received.

Results

Of the 183 patients, 57 who were treated conservatively had less abdominal tenderness, lower levels of serum C-reactive protein, and shorter time to presentation than the 126 patients who underwent emergency surgery. There was no significant difference in baseline characteristics between the 41 successful patients and 16 failed patients in the conservative treatment group; however, the latter had a longer average hospital stay. Eighty-three of the emergency surgery patients who underwent gastrectomy had longer surgical times, greater blood loss, and shorter time to resumption of diet than the 57 patients undergoing stomach-preserving surgery; however, there was no significant difference in postoperative complications and hospital stay between these groups. Of 91 patients who received stomach-preserving treatment, only three had treatment failure in the long-term follow-up period.

Conclusion

Strictly selected patients should be initially considered for conservative treatment. The short-term outcomes of stomach-preserving surgery are comparable to gastrectomy; however, further evaluation of the long-term outcomes of stomach-preserving treatment is required.

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Acknowledgments

We thank Drs. S. Shimoda (Shibata Hospital), N. Shimakage (Nagaoka Red Cross Hospital), K. Sato (Sado General Hospital), M. Hasegawa (Niigata Prefectural Central Hospital), H. Okamoto (Yoshida Hospital), K. Miyashita (Tsubame Rosai Hospital), T. Tada (Tachikawa General Hospital), K. Ueki (Kashiwazaki General Hospital and Medical Center), O. Sato (Shinrakuen Hospital), M. Ohtake (Niigata Saiseikai Sanjo Hospital), A. Nashimoto (Niigata Cancer Center Hospital), S. Tanaka (Niigata Prefectural Koide Hospital), T. Tomiyama (Toyosaka Hospital), and M. Sasagawa (Nanbugo General Hospital) for assistance with the data collection.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-756 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan

    Ryo Tanaka, Shin-ichi Kosugi, Kaoru Sakamoto, Kazuhito Yajima, Takashi Ishikawa, Tatsuo Kanda & Toshifumi Wakai

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  1. Ryo Tanaka
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  2. Shin-ichi Kosugi
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  3. Kaoru Sakamoto
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  4. Kazuhito Yajima
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  5. Takashi Ishikawa
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  6. Tatsuo Kanda
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  7. Toshifumi Wakai
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Correspondence to Shin-ichi Kosugi.

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Tanaka, R., Kosugi, Si., Sakamoto, K. et al. Treatment for Perforated Gastric Ulcer: a Multi-institutional Retrospective Review. J Gastrointest Surg 17, 2074–2081 (2013). https://doi.org/10.1007/s11605-013-2362-7

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  • DOI: https://doi.org/10.1007/s11605-013-2362-7

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