Perforated peptic ulcer: to close or patch - a century-old controversy
Khalid Mahmoud1, Mohamad K Abou Chaar1, Daniel Stephens1
1Surgery Research Office; Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States.
Summary
Sutured closure of perforated peptic ulcers is linked to a lower leak risk compared to patch-only repairs. Immunosuppression and elevated lactate levels also increase leak probability.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Outcomes Research
Background:
- Perforated peptic ulcers present a significant surgical challenge.
- Choosing the optimal repair technique is crucial for patient outcomes.
Purpose of the Study:
- To compare the effectiveness of different surgical techniques for perforated peptic ulcer repair.
- To identify factors associated with post-operative leaks.
Main Methods:
- Retrospective review of 277 patients undergoing surgery for perforated peptic ulcers (2004-2021).
- Analysis of various repair methods including suture closure, patch repair, and gastrectomy.
- Logistic regression used to identify independent predictors of leakage.
Main Results:
- Sutured closure was associated with a lower leak rate than patch-only repair.
- No leaks occurred with stapled wedge resection.
- Independent predictors of leakage included lack of suture closure (OR 7.0), immunosuppression (OR 5.5), and lactate levels (OR 1.4).
Conclusions:
- Sutured closure is preferred over patch-only techniques for perforated peptic ulcers when feasible.
- Findings suggest caution due to the study's retrospective, single-institution design.
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