Perforated peptic ulcer: close or patch a century-old controversy.

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery Pub Date : 2025-02-14 DOI:10.1016/j.gassur.2025.101993

Khalid Mahmoud, Mohamad K Abou Chaar, Daniel Stephens, John M Zietlow, Stephanie F Heller, David Turay, Veljko Strajina

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引用次数: 0

Abstract

Background: The study aims to establish which surgical technique used for the repair of perforated peptic ulcers is associated with more favorable outcomes.

Methods: A retrospective chart review of the patients who underwent surgery for perforated peptic ulcers at the Mayo Clinic Rochester campus between 2004 and 2021 was performed.

Results: The final analysis included 277 patients: 182 suture closure of the perforation, 55 patch-only repairs, 15 gastrectomies with reconstruction, 14 wedge resections, and other techniques in 11 patients. There were no leaks in patients who had stapled wedge resection. Among patients with repair of the perforation (n=237), three variables associated with the leak on univariate analysis were included in a logistic regression model. All three were independently associated with a leak: lack of suture closure of the perforation (OR 7, 95% CI 2.5-19.1), immunosuppression (OR 5.5, 95% CI 1.7-17.6), and lactate levels (OR 1.4, 95% CI 1.1-1.7).

Conclusion: When both sutured and patch-only closure techniques are feasible for a perforated peptic ulcer, sutured closure is associated with a lower risk of leakage. However, given our study's retrospective, single-institution nature, the findings should be interpreted cautiously.

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背景：该研究旨在确定哪种外科技术用于修复穿孔性消化性溃疡的疗效更好：该研究旨在确定用于修复穿孔性消化性溃疡的哪种手术技术与更有利的治疗效果相关：方法：对2004年至2021年间在梅奥诊所罗切斯特分院接受消化性溃疡穿孔手术的患者进行回顾性病历审查：最终分析包括277名患者：182例患者进行了穿孔缝合，55例患者进行了补片修复，15例患者进行了胃切除术和重建术，14例患者进行了楔形切除术，另有11例患者采用了其他技术。采用订书钉楔形切除术的患者没有发生渗漏。在修复穿孔的患者（237 人）中，单变量分析中与渗漏相关的三个变量被纳入逻辑回归模型。这三个变量都与渗漏独立相关：穿孔未缝合（OR 7，95% CI 2.5-19.1）、免疫抑制（OR 5.5，95% CI 1.7-17.6）和乳酸水平（OR 1.4，95% CI 1.1-1.7）：结论：在对消化性溃疡穿孔同时采用缝合和贴片两种闭合技术时，缝合闭合的渗漏风险较低。然而，鉴于我们的研究是一项回顾性研究，且仅在一家机构进行，因此应谨慎解读研究结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.