Late results of a simple closure technique and Helicobacter pylori eradication in duodenal ulcer perforation

The aim of this study is to determine the incidence of Helicobacter pylori (H. pylori) in patients operated on for duodenal ulcer perforation and to evaluate the late results of a simple closure technique in patients positive and negative for H. pylori.

The data of 84 patients who underwent simple closure for duodenal ulcer between 2003-2007 were retrospectively studied. Antral biopsy material taken from all patients during laparotomy was studied with the rapid urease test and the patients were then separated into 2 groups. Group 1 (H. Pylori positive) received postoperative H. pylori eradication treatment, and Group 2 (H. pylori negative) received only lansaprasol treatment after surgery. All patients were evaluated with upper gastrointestinal endoscopy on the 6th and 14th postoperative weeks. Primary treatment failure was considered in patients who had non-healing ulcers after 14 weeks. Patients with healed ulcers were scheduled for annual examinations. The results were compared between the groups.

The rate of H. pylori infection in duodenal ulcer perforation was found to be 80.9%. Ulcer healing rates on the postoperative 6th and 14th weeks were 88.2% and 97.5% in the first group, and 68.8% and 81.2% in the second group, respectively. Mean postoperative follow-up was 41.28 +/- 17.63 (range 17-73) months. Ulcer recurrence rate was found to be 4.54% in Group 1 and 30.76% in group 2 (p = 0.012).

All patients with a perforated peptic ulcer should be treated with simple closure of the perforation followed by medical therapy aimed at healing the ulcer. We believe that H. pylori negative patients have more risk of recurrence and such patients require close postoperative follow-up.