Peptic ulcer surgery in patients with liver cirrhosis

This study identified risk factors of surgical treatment for gastroduodenal ulcer disease in patients with liver cirrhosis.

Liver cirrhosis is frequently associated with complicated peptic ulcer disease. Surgery in liver cirrhotics has a high mortality and morbidity especially when abdominal operations are performed.

Sixty-nine patients undergoing surgery for gastroduodenal ulcer disease between 1972 and 1991 were studied, retrospectively.

Ninety percent of patients required emergency surgery for bleeding ulcer (n = 45) or perforation (n = 17). Mortality was 29% for elective patients (n = 7), 35% for patients with perforation and 64% for patients with bleeding. Overall mortality of 69 patients was 54%. Only 15 of 69 patients (22%) had an uncomplicated postoperative course. Postoperative bleeding, septic complications, and renal failure were the most frequent postoperative complications. Bleeding and multiple organ failure were the leading causes of death in 70% of patients. A univariate analysis determined preoperative hemoglobin < 12 g/L (p < 0.05), systolic blood pressure < 100 mm Hg (p < 0.025), prothrombin time < 60% (p < 0.05) and the presence of portal hypertension (p < 0.01) as prognostic factors. No significant correlation with survival could be established for excretory liver function (serum bilirubin) and partial thromboplastin time.

To improve treatment results it is recommended (1) to substitute blood products (particularly coagulation factors) early and in sufficient quantities, (2) to diligently search for and to treat septic foci and administer antibiotics in a nonrestrictive manner, and (3) to restrict the operative procedure to the treatment required for control of the ulcer complication.