Routine use of laparoscopic repair for perforated peptic ulcer.

BACKGROUND: Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair for perforated peptic ulcer in routine clinical practice. METHODS: This was a prospective analysis of 172 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 1997 and June 2003. RESULTS: One hundred and seventy-two patients of mean age 54 (range 14-93) years had perforated peptic ulcer diagnosed by laparoscopy. There were 172 duodenal ulcers, 22 prepyloric and 13 non-juxtapyloric gastric ulcers. One hundred and sixty-five patients underwent omental patch closure of perforations; there were six Pólya gastrectomies and one ulcerectomy. Thirty-seven patients (21.5 per cent) required conversion to laparotomy. The mean operating time was 64.8 (range 14-180) min. The median postoperative requirement for intramuscular pethidine was one dose. The median postoperative hospital stay was 6 days. Complications occurred in 28 patients (16.3 per cent) resulting in three reoperations. Six patients with intra-abdominal collections were managed by percutaneous drainage. Two patients who underwent conversion developed a wound infection. Fourteen patients (8.1 per cent) died, 11 of whom were American Society of Anesthesiologists grade III and IV. CONCLUSION: Laparoscopic repair of perforated peptic ulcer is a safe emergency procedure in routine clinical practice for patients with perforated pyloroduodenal ulcer.

The development of educational programs for small-scale business women managers.

PIP: Results of a survey of demand for education among women managers of small-scale businesses in Korea are provided. Personal interviews were conducted by the Korean Women Development Institute in 1988 among 56 prospective women managers and 15 women managers and 32 experts. A pilot education program was held in 1988 and 1989; 69 women completed the course. Educational objectives are to give women an opportunity to learn the basic rudiments of running a business and develop the self-confidence to undertake this venture. The general objectives, management, evaluation, and postguidance of an educational program for women managers is given in addition to curriculum descriptions of several model programs in general and specifically directed to women. A profile of women surveyed is given; most had completed education beyond high school and were married. 66% planned to use their own money. In self-preparation for the establishment of a business, 26.9% of women used published market surveys and the advice of women already in business. 8 out of the 15 women managers had used their own start-up money. Net monthly earned income for women managers ranged from 500,000 won to 1.5 million won. Women worked 14-15 hour days. Some took holidays. Obstacles articulated by prospective managers were the lack of professional knowledge and experience and difficulties in human relationships due to lack of self-confidence and negative character. Difficulties expressed by women managers were lack of funding for expansion and maintenance of the business, of up-to-date technology, of information on the circulation of merchandise, credit dealings with customers, pricing, health, and laws. 78.5% of prospective women reported no confidence in management skills while most managers were satisfied. 54.2% reported feeling more confident after the pilot course and 39.0% had acquired skills. Content recommended included items on investment, site selection, and business planning for prospective managers, while managers preferred content on site selection, sale strategy and management of customers, and display of merchandise. Training periods suggested ranged from 4 to 7 days during the day. The focus should be on cases and experiences and personnel should be expert in the field.^ieng