Evaluación posoperatoria de los pacientes con úlcera perforada / Postoperative evaluation of patients operated on perforated gastro-duodenal ulcer

Introducción: la úlcera péptica gastroduodenal constituye después de la hemorragia la complicación ulcerosa más frecuente y la más grave de todas. Ocurre entre el 2 y 5 porciento de los pacientes con enfermedad ulcerosa y sus síntomas son provocados por la acción del jugo gástrico derramado en la cavidad abdominal. Objetivo: valorar la evolución de los pacientes operados de urgencia con el diagnóstico de úlcera gastroduodenal perforada. Métodos: se realizó un estudio observacional descriptivo con carácter prospectivo en el periodo comprendido entre enero del 2005 y diciembre del 2011. El universo estuvo constituido por todos los pacientes intervenidos quirúrgicamente por úlcera gastroduodenal perforada en el servicio de Cirugía General del Hospital General Docente Enrique Cabrera durante ese período. Los datos fueron transferidos a una planilla de recolección de datos que posteriormente fue procesada y analizada en el Microsoft Office Excel 2007. Los resultados se expresaron en tablas y gráficos, y solo se usaron técnicas de estadística descriptiva; distribuciones de frecuencia absolutas y relativas para las variables cuantitativas y media aritmética para las cuantitativas. Resultados: el grupo de edad predominante fue de mayores de 60 años con 42,4 porciento. El sexo masculino fue el de mayor incidencia con un 88 porciento. La asociación tabaco más café y solo tabaco constituyeron los hábitos tóxicos más frecuentes con 23,1 porciento cada uno. El dolor abdominal estuvo presente en el 100 porciento de los pacientes. La radiografía de tórax con el paciente de pie fue el estudio complementario más utilizado para corroborar la sospecha diagnóstica. En el 77 porciento de los pacientes se evidenció el neumoperitoneo radiológico. La úlcera duodenal fue la localización más frecuente (19 pacientes). En 15 pacientes (57,7 por ciento) se realizó la sutura y epiploplastia como tratamiento de urgencia. La complicación postoperatoria más frecuente fue la dehiscencia de la herida quirúrgica. Un paciente falleció en el postoperatorio con diagnóstico de bronconeumonía. Conclusiones: los pacientes mayores de 60 años de edad y del sexo masculino constituyeron el mayor número con el diagnóstico de úlcera gastroduodenal perforada. La localización más frecuente de la úlcera fue en el duodeno. La sutura y epiploplastia fue el proceder más utilizado como tratamiento. La dehiscencia de la sutura fue la complicación que más se observó en la serie(AU)

Introduction: Perforated peptic gastroduodenal ulcer represents the most frequent and serious complication after hemorrhage. It occurred in 2 to 5 percent of patients diagnosed as peptic ulcer and the main symptoms are caused by the gastroduodenal content spilled over the peritoneal cavity. Objective: To assess the recovery of patients operated on from perforated gastroduodenal ulcer at emergency setting. Methods: Prospective, observational and descriptive study carried out from January 2005 through December 2011. The universe of study was all the patients operated on from perforated gastroduodenal ulcer in Enrique Cabrera general teaching hospital's general surgery service in this period. Data were collected in forms, which were processed and analyzed by using Microsoft Office Excel 2007. The results were provided in tables and graphs; summary statistics, absolute and relative distribution for quantitative variables and arithmetic median for the quantitative ones were the statistical techniques used. Results: Men over 60 years old were the main group of patients with this pathology( 42.2 percent). The highest incidence rate was found in males (88 percent).Toxic habits like coffee plus cigar, and coffee alone were the most frequent, accounting for 23.1 percent each. All the patients complained of acute epigastric pain. Chest Rx on standing position was the most used study to confirm the suspected diagnosis. Radiological pneumoperitoneum was evident in 77 percent of patients. Duodenal ulcer was the main location of perforation (19 patients). Suture and epiploplasty were performed as emergency treatment in 15 patients (57.7 percent). Surgical wound dehiscence was the most common complication. One patient died from bronchopneumonia during the postoperative phase. Conclusions: Patients aged over 60 and males represented the highest number with diagnosis of perforated gastroduodenal ulcer. The most frequent location was duodenum. Epipoplasty and suture were the main therapeutic methods. Suture dehiscence was the most observed complication in this group(AU)

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients / Estudo comparativo quanto à recidiva ulcerosa do tratamento cirúrgico de úlcera péptica perfurada entre pacientes H. Pylori positivos, após erradicação, e negativos

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done.AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori.METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months.RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients.CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

RACIONAL: O tratamento cirúrgico da úlcera péptica perfurada é assunto discutível. Os cirurgiões, por muitos anos, fizeram suas opções entre procedimentos de redução ácida, somente fechamento da perfuração - porém com maior chance de recidiva ulcerosa. Desde a comprovada vinculação da úlcera péptica e suas complicações à infecção gastroduodenal causada pelo Helicobacter pylori, houve recomendação para mudança na atitude dos cirurgiões na volta à operação mais simples com erradicação da bactéria.OBJETIVO: Analisar a recidiva ulcerosa em pacientes com úlcera perfurada H. pylori positiva que foram submetidos à simples sutura da lesão e omentopexia com erradicação da bactéria e compará-la com H. pylori negativo submetido ao mesmo tratamento cirúrgico.MÉTODOS: Cento e quatorze pacientes com úlceras pré-pilóricas, pilóricas e duodenais perfuradas foram atendidos com fechamento simples. Trinta dias após a operação submeteram-se à endoscopia digestiva alta com biópsias para testes da urease e histopatológicos. Foram divididos em dois grupos de acordo com o resultado dos testes: positivo e negativo.Os positivos foram erradicados e, junto com o grupo negativo, foram seguidos com endoscopias semestrais e testes de detecção para H. pylori procurando por recidiva ulcerosa e reinfecção no grupo erradicado.RESULTADOS: O grupo positivo foi formado por 25 pacientes, dos quais dois foram considerados não erradicáveis segundo os critérios do protocolo. Os demais foram seguidos por período médio de 38,21 meses e detectadas recidivas em quatro pacientes (17,39%), metade deles (8,69%) foram reinfectados. O grupo negativo foi formado por 26 pacientes, seguido por período médio de 38,28 meses e oito (30,76%) apresentaram recidiva ulcerosa. Não foi evidenciada diferença estatisticamente significativa entre os grupos...

Effect of early enteral feeding after upper gastrointestinal surgery.

BACKGROUND AND AIMS: The impact of early enteral nutrition in elective upper gastrointestinal surgery was the focus of this study, with particular reference to its feasibility and benefits. METHOD: This prospective study was carried out over 2 years. The study group included 30 patients and the control group had 31patients. Twenty-two patients in each group underwent truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer and gastric outlet obstruction. Eight patients in the study group and nine in the control group underwent gastrectomy for carcinoma stomach. A standard milk-based diet was initiated 12 hours after surgery through a nasojejunal tube. The patients were monitored for side effects of enteral feeding and postoperative infective complications. Nitrogen balance and nutritional parameters like the body weight, serum albumin, and serum transferrin were measured pre and postoperatively. RESULTS: The groups were comparable with respect to age, sex, and preoperative nutritional factors like body weight, serum albumin, and serum transferrin. The return of bowel sounds and passage of flatus took place significantly earlier in the study group (1.43 vs. 2.81 days). Diarrhoea and abdominal cramps were the significant complications noted in the study group in relation to early enteral feeding. No patient required withdrawal of enteral feeds. They showed a positive nitrogen balance on the fourth postoperative day. The patients in the study group showed significant increase in the serum transferrin level compared with the preoperative level but the serum albumin level was not significantly altered. CONCLUSION: Early enteral feeding through the nasojejunal tube following elective upper gastrointestinal surgery is feasible, safe and improves the nutritional status.

Surgical management of combined perforated and bleeding duodenal ulcer

Peptic ulcer is one of the most frequent diseases of the alimentary tract, while mortality from perforated peptic ulcer still remains high. We conducted this retrospective study to determine the adverse operative risk factors for perforated hemorrhagic peptic ulcers in Shiraz, southern Iran. 896 patients with peptic ulcer were enrolled. A questionnaire was used to collect the data on age, gender, site of ulcer, presentation, endoscopic findings, type of peptic ulcer complications, method of treatment, surgical procedure, and results of the treatment. Complicated duodenal ulcer was 15% in period I, and 11.5% in period II [P>SD of the age of +/- 0.05]. The mean 11 years. The age of the patients with perforated duodenal the patients was 42.7 8.6 years. Perforation with 12.5 and in hemorrhagic patients 37.4 +/- ulcer was 48 hemorrhagic duodenal ulcer in the first period was 1.2% and in second period, 0.2%. In the second period, simple closure was done in 29 [74%] patients, and in perforated DU cases, conservative management was done in 23 [56%] patients. Although the number of complicated duodenal ulcer cases increased from period I to period II, complications of duodenal ulcer [Kissing disease] significantly decreased

Emergency operations for bleeding duodenal ulcer: a simple option to consider: Case report

We report a 46 years-old man who had severe bleeding from a posterior duodenal ulcer [DU] that was diagnosed but could not be treated endoscopically in another health facility. He went into shock as he was being admitted to the casualty at Khartoum North Teaching Hospital [KNTH]. His haemoglobin [Hb] dropped to five gram/dl. He required resuscitation and transfusion of six units of blood overnight. Emergency surgery was performed. Over sewing [OS] of the ulcer was done and the stenosed first part of duodenum was closed transversely [pyloroplasty]. No acid-reducing procedure [ARP] was done. The patient received anti- helicobacter therapy via the intravenous route preoperatively and continued postoperatively. This was later given orally after he started taking by mouth. He made an uneventful recovery with no recurrence of bleeding and was discharged home one week latter. Endoscopy was done at KNTH six weeks later. This showed complete healing of the ulcer with no evidence of Helicobacter pylori in the biopsies taken. We found simple OS of the bleeding DU together with anti-helicobacter therapy safe, efficient, and not associated with re-bleeding. We discuss the rationale of this simple treatment. We propose the need for a randomized controlled study comparing it with acid-reducing procedure [ARP] as options in the surgical treatment of bleeding DU

Jejunogastric intussusception--a rare cause of recurrent upper gastrointestinal bleeding: case report and review of literature.

Jejunogastric intussusception is a known complication following gastrojejunostomy. However, only occasionally have they presented with haematemesis and we are unaware of any case where it led to recurrent haematemesis. We describe a case where the patient developed recurrent upper gastrointestinal bleeding due to recurrent episodes of jejunogastric intussusception following gastrojejunostomy performed 12 years earlier for duodenal ulcer disease.

Factibilidad de la vagotomía altamente selectiva con piroloplastia en la estenosis duodenal péptica / Feasibility of highly selective vagotomy with pyloroplasty in peptic duodenal stenosis

Se realizó un estudio prospectivo controlado, a simple ciega, en el Hospital Militar Central Dr Carlos J. Finlay durante un período de 16 años, con el objetivo de comprobar la factibilidad de la vagotomía altamente selectiva con piroloplastia en la estenosis duodenal péptica. Se comparó con la vagotomía altamente selectiva más duodenoplastia. La técnica de vagotomía altamente selectiva fue la modificación de Hill-Barker en ambos grupos. El estudio comprendió 64 pacientes, 51 hombres y 13 mujeres, con una edad promedio de 47 años. No hubo complicaciones intraoperatorias ni muertes. Se presentaron complicaciones posoperatorias tempranas en el 46,9 por ciento del grupo estudio y en 31,3 por ciento del grupo control, pero fueron leves y desaparecieron antes de los 3 primeros meses. Hubo 2 recidivas ulcerosas (6,3 por ciento) en el grupo estudio, no asociadas con la técnica. Los resultados clínicos fueron satisfactorios en el 96,9 por ciento del grupo control y en el 90,6 por ciento del grupo estudio, sin que se demostrara asociación con el proceder quirúrgico. Por tanto, la piloroplastia no anula los excelentes resultados de la vagotomía altamente selectiva.

A single-blind controlled prospective study was performed in Dr Carlos J. Finlay Central Military Hospital over o period of 16 years, to verify feasibility of a highly selective vagotomy with pyloroplasty in peptic duodenal stenosis. The highly selective vagotomy technique was of the Hill-Barker modification in both groups. Study included 64 patients, 51 males and 12 females aged as average 47. There wasn't intraoperative complications neither deaths. Early postoperative complications were present in 46.9 percent of study group, and in 31.3 percent of control group, but these were slights and disappeared before the three first months. There was two ulcerative relapses (6.3 percent) in study group, non-associated with technique. Clinical results were satisfactory in 96,9 percent of control group, and in 90.6 percent of study group, without association with surgical procedure. Thus, pyloroplasty don't invalidates excellent results of highly selective vagotomy.

Vagotomía altamente selectiva convencional versus modificación de Hill-Barker en la úlcera péptica duodenal / Conventional highly selective vagotomy versus Hill-Baker´s modification in treating duodenal peptic ulcer

Se realizó un estudio prospectivo al azar a simple ciegas en el Hospital Militar Central "Dr Carlos J Finlay", durante un periodo de 20 años con el objetivo de comparar la vagotomía altamente selectiva convencional (VAS= 62 pacientes) y la modificación de Hill-Barker, vagotomía altamente selectiva anterior con troncular posterior (VASA + VTP= 69 pacientes) en el tratamiento de la úlcera péptica duodenal. El tiempo de seguimiento promedio fue de 10,8 años (rango de 2 a 20 años). No hubo complicaciones ni mortalidad operatorias. La VASA + VTP tuvo un tiempo quirúrgico significativamente menor que la VAS. Las complicaciones posoperatorias tempranas fueron en su mayoría ligeras y pasajeras en ambos grupos, pero las diarreas se asociaron significativamente con la VASA + VTP. Las recidivas se presentaron en el 11,3 por ciento de la VAS y en el 7,2 por ciento de la VASA + VTP. Los resultados clínicos fueron satisfactorios en el 87 por ciento de ambos grupos y no hubo asociación significativa en la comparación de ambas técnicas. Se demostró que la modificación de Hill-Barker es una alternativa por su rapidez y menor complejidad

Tumores estromales gastrointestinales duodenales: Report of one case / Duodenal gastrointestinal stromal tumors. Report of one case

Gastrointestinal stromal tumors (GIST) are lesions whose diagnosis and treatment have varied in the last decade. We report a 76 year-old male with a history of eight episodes of upper gastrointestinal bleeding. A duodenography showed an elevated lesion in the third portion of the duodenum with a central ulceration. It was initially managed with tumorectomy and primary closure of the duodenum. The pathological study of the surgical specimen revealed a low grade gastrointestinal stromal tumor. Three years later, the tumor recurred and pancreatoduodenectomy was performed. Due to the high risk of malignant potential, tumor size, number of mitoses and the presence of necrosis, imatinib mesylate was started. The patient had a satisfactory evolution, without evidences of recurrence after 15 months of follow up.

External duodenal fistula following closure of duodenal perforation.

AIM: Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN). METHOD: Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery. RESULTS: Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality. CONCLUSIONS: EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.

La endoscopía en la Hemorragia digestiva alta: la visión del cirujano / Upper gastrointestinal endoscopy in patients with bleeding

Antecedentes: En la hemorragia digestiva alta (HDA), la endoscopia digestiva alta (EDA) constituye un examen de diagnóstico de importancia fundamental. Objetivos: Evaluar en que medida la EDA contribuyó eficazmente a definir conductas y detener la hemorragia, y comparar los resultados de esta experiencia con los de la literatura. Material y Método: Estudio retrospectivo. 100 pacientes consecutivos internados a partir de junio de 1997 por HDA con compromiso hemodinámico. Todos fueron sometidos a una EDA en las primeras 24 hs de la manifestación inicial del sangrado. En los casos sin diagnóstico y en los que el hallazgo endoscópico correspondió a un sangrado activo o reciente, se efectuó una segunda endoscopia dentro de las 48 hs. La evolución de los pacientes se evaluó en función de tres variables: el resangrado, la necesidad de cirugía y la mortalidad. Resultados: En el 32 por ciento de los casos el diagnóstico del primer estudio fue modificado por los estudios ulteriores, y de los 8 pacientes en los que la primera endoscopía no fue diagnóstica, se produjo resangrado en 4 y fallecieron 2. De los 19 pacientes tratados por vía endoscópica por hemorragia no varicosa, se produjo resangrado en 5 (26 por ciento), mientras que en 15 pacientes sin tratamiento endoscópico, el resangrado fue del 33,3 por ciento (p=0,850). En total se produjo resangrado o persistencia en 24 pacientes, se operaron 13 de ellos como urgencia, y de éstos 2 fallecieron (15,2 por ciento). Por el contrario, hubo 11 pacientes con resangrado o persistencia no operados, en ellos la mortalidad fue del 45 por ciento (p=0,122). La mortalidad en los pacientes con diagnóstico endoscópico fue de 6,5 por ciento y la de los que no lo tuvieron fue del 25 por ciento, sin embargo esta diferencia no fue significativa (p=0,243). Conclusiones: No observamos un criterio uniforme para la descripción endoscópica de las lesiones ni para categorizarlas de acuerdo a los criterios de Forrest y se observó una alta incidencia de resangrado en los pacientes que recibieron tratamiento endoscópico. En los pacientes en que la primera endoscopia no es eficaz como método de diagnóstico, el pronóstico es más grave, y entre los pacientes que resangraron, la mortalidad fue menor entre los que recibieron tratamiento quirúrgico que no fueron operados

Vagotomía altamente selectiva en la úlcera duodenal complicada / Highly selective vagotomy in the complicated duodenal ulcer: 18 years of experience

Se realizó un estudio descriptivo-retrospectivo de los pacientes operados de úlcera duodenal complicada por la técnica de vagotomía altamente selectiva, en el Hospital Militar Central "Dr. Carlos J. Finlay", en el período comprendido entre 1984-2001. El objetivo principal fue presentar los resultados obtenidos en 2 variantes de esta técnica. Se operaron un total de 211 pacientes, de los cuales pudieron ser evaluados 192. El 31,2 por ciento (60 pacientes) tenían estenosis que necesitaron de un proceder de drenaje (duodenoplastia o piloroplastia). Se realizó la técnica de Hill-Barker en 116 pacientes y la de Johnston-Wilkinson en 76 pacientes. El tiempo quirúrgico promedio por operación fue de 134,5 min. Se presentaron complicaciones posoperatorias tempranas en el 36,7 por ciento de los pacientes a predominio de las diarreas. La mayoría de estas complicaciones cesaron en los 3 primeros meses del posoperatorio. Hubo recidivas en el 6,8 por ciento de los casos. Los resultados según evaluación clínica de Visick fueron satisfactorios en el 90,6 por ciento de los pacientes

Effect on gallbladder function subsequent to truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer.

The effect of truncal vagotomy on gallbladder function and on the incidence of lithogenesis has remained controversial. A prospective and retrospective investigational study was undertaken to evaluate the effect of truncal vagotomy and gastrojejunostomy on gallbladder function. The study included a total of 76 patients and 77 controls. In Group I (Prospective group), 32 consecutive patients with chronic duodenal ulcer and gastric outlet obstruction undergoing truncal vagotomy and gastrojejunostomy were included. Group II included 25 age and gender matched controls (prospective group). Group III included 44 patients who had undergone truncal vagotomy and gastrojejunostomy 3 years or more prior to presentation (Retrospective group) and Group IV included 52 age and gender matched controls for the retrospective group. The patients in the prospective groups were followed up for a period of 1 year. An alkaline tide test was done in the prospective and retrospective group to assess for the completeness of vagotomy. Gallbladder contractile response to fatty meal and the presence of stones and sludge were noted in all the four groups by ultrasonography. There were 30 patients in the prospective group and 40 in the retrospective group after excluding patients with incomplete vagotomy. On ultrasound examination, there was no significant difference in the gallbladder volume and contractility of the study group when compared with the controls. Gallbladder sludge was found in 16 to 25% of patients in the prospective group (group I) during follow up, where as similar finding was documented in 8% of the matched control (group II (P>0.1). However, in the retrospective (group III) 10% (4 out of 40) had calculi and 20% of patients demonstrated sludge which was significantly higher when compared with the controls (p = 0.001). Truncal vagotomy and gastrojejunostomy did not affect gallbladder contractility, but it might predispose to the formation of sludge and subsequent calculi in a proportion of patients in long term.

Operaciones conservadoras de órganos en la úlcera péptica duodenal / Conserving-organ operations in duodenal peptic ulcer

Se realizó un estudio descriptivo de los resultados obtenidos del tratamiento quirúrgico electivo de la úlcera péptica duodenal en 107 pacientes durante el periodo de 1985 a 1995. Se utilizaron como procederes quirúrgicos la vagotomía altamente selectiva en 56 pacientes y la vagotomía altamente selectiva anterior con vagotomía troncular posterior en 51 pacientes. La indicación quirúrgica más frecuente fue la no respuesta al tratamiento médico en el 90,7 por ciento de los casos. De ambas técnicas, la vagotomía altamente selectiva anterior con vagotomía troncular posterior fue la de menor tiempo quirúrgico y menor estadía posoperatoria. El 32,7 por ciento de los pacientes tuvieron complicaciones posoperatorias. La disfagia (14 por ciento) y las diarreas (17 por ciento) fueron las más frecuentes. Hubo recidivas en el 4,6 por ciento de los casos. Se obtuvieron buenos resultados, según la clasificación de Visick, en el 92,6 por ciento de los pacientes y no hubo mortalidad posoperatoria

Surgical management of perforated duodenal ulcer: the changing scene

To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58 of cases presented before age 50 years. Perforations in acute ulcers occurred in 80 of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11 of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers

Avaliação dos fatores de risco de mortalidade no tratamento cirúrgico das úlceras gástrica e duodenal perfuradas / Assessment of mortality risk factors in the surgical treatment of perforated gastric and duodenal ulcers

Racional - Avaliar os fatores de risco de mortalidade dos pacientes submetidos a tratamento cirúrgico das úlceras gástrica e duodenal perfuradas. Casuística e Métodos -Em estudo retrospectivo foram analisados 311 prontuárioscom úlcera péptica perfurada submetidos ao tratamento cirúrgico no Hospital de Urgência de Goiânia no período de Janeiro/1977 a Dezembro/2000...

Anterior or posterior gastro-jejunostomy with truncal vagotomy for duodenal ulcer--are they functionally different?

Truncal vagotomy with gastrojejunostomy (GJ) is the standard treatment for chronic cicatrizing duodenal ulcer with gastric outlet obstruction. We tried to determine if a significant functional difference exists in the early and late outcomes following anterior and posterior types of GJ to treat this condition. The case records of 106 patients who underwent truncal vagotomy and GJ at our institute from 1 January 1995 to 31 December 1999 were studied retrospectively. Patients were followed up with a personal interview. Perioperative and long-term parameters were compared in the anterior and posterior G.I. groups. Sixty-five patients (61.32%) were followed up; 31 in the anterior group and 34 in the posterior group. The median follow-up was 5 years (range 2.5-7.5 years). Except for a significant difference in length of afferent loop (p < 0.0001), there were no significant differences in the duration of hospital stay, nasogastric aspirates on postoperative days 1, 2, 3 and 4 and the day the nasogastric tube was removed. Early postoperative complications were uncommon and not different in the two groups and long-term outcomes were similar. The Anterior GJ, being technically easier and needing less operative time, may be advocated in all cases of chronic duodenal ulcer, with gastric outlet obstruction requiring truncal vagotomy and drainage.

Cirugía del hiato esofágico. Abordaje videolaparoscópico / Surgery of esophageal hiatus. Videolaparoscopic approach

Desde comienzos de la década de los 90, la realización de la cirugía del hiato esofágico (tratamiento de la enfermedad por reflujo gastroesofágico, de la acalasia esofágica, cirugía denervativa gástrica en el tratamiento de la ulcera duodenal crónica) mediante un abordaje videolaparoscópico, ha logrado una gran difusión y aceptación a nivel mundial. La excelente exposición y visualización de una región anatómica, profundamente situada en el hemiabdomen superior, a lo que se suman las ventajas del abordaje mínimamente invasivo, logrando resultados a corto y mediano plazo comparables a la cirugía convencional explican este fenómeno. Los autores comunican su breve experiencia inicial en esta cirugía y realizan una revisión de la literatura, con especial énfasis en la técnica quirúrgica. Se operaron 23 pacientes: 14 funduplicaturas de Nissen Rossetti, 4 miotomías asociadas a funduplicaturas de diferente tipo y cinco cirugías denervativas gástricas por ulcera duodenal. Hubo 2 conversiones, ambas por perforación esofágica. No hubo complicaciones mayores postoperatorias y la mortalidad fue nula. Los resultados funcionales fueron buenos. Los resultados obtenidos, coincidentes con la bibliografía internacional apoyan la continuación de esta línea de trabajo.