n South African Journal of Surgery - Perforated gastric ulcer - reappraisal of surgical options : general surgery
|Article Title||Perforated gastric ulcer - reappraisal of surgical options : general surgery|
|© Publisher:||Medpharm Publications|
|Journal||South African Journal of Surgery|
|Author||T.E. Madiba, R. Nair, T.V. Mulaudzi and S.R. Thomson|
|Publication Date||Aug 2005|
|Pages||58 - 60|
<I>Background.</I> The available operative procedures for perforated gastric ulcer are gastrectomy, ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. <br><I>Patients and methods.</I> Seventy-two patients (mean age 43 years, 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. <br><I>Results.</I> Partial gastrectomy was performed in 27 patients, ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18% (26% for gastrectomy, 19% for ulcer excision and 5% for patch closure). Shock on admission (p = 0.006) and <i>Candida</i> (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. <br><I>Conclusion.</I> Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases.
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