exudates and Peptic-Ulcer-Perforation

The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution.. This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014.. A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n=63, 48.1% vs. open repair, n=68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p=0.434), gender (p=0.305), body mass index (p=0.180), and presence of comorbidities (p=0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p=0.769), Boey scores 0/1 (p=0.311), Mannheim Peritonitis Index > 27 (p=0.528), shock on admission (p<0.99), and the duration of symptoms > 24 hours (p=0.857). There was no significant difference in the operating time between the two groups (p=0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p=0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p=0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p=0.008) and lower pain scores in the immediate postoperative period (p<0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99).. Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group.

Topics: Academic Medical Centers; Adult; Aged; Cohort Studies; Databases, Factual; Emergencies; Female; Follow-Up Studies; Gastrectomy; Humans; Laparoscopy; Laparotomy; Length of Stay; Malaysia; Male; Middle Aged; Minimally Invasive Surgical Procedures; Operative Time; Pain, Postoperative; Peptic Ulcer Perforation; Quality Improvement; Retrospective Studies; Risk Assessment; Stomach Ulcer; Treatment Outcome; Young Adult

Perforated peptic ulcers (PPU) present as serious surgical emergencies that carry high mortality and morbidity. Foreigners with PPU are also managed in our hospital setting. Their inclusion significantly alters the trend and pattern of PPU seen in Malaysia.. To compare per-operative and post-operative features and outcomes of perforated peptic ulcers between Malaysians and foreigners.. This was an analytical crosssectional study. All patients who underwent repair of perforated peptic ulcer disease during a 6-year period were included. 50 consecutive patients' records with perforated peptic ulcer were analysed. Data were collected from operation theatre database and hospital medical records. Chi square and t test were performed using SPSS statistical software.. Total of 50 patients, of which 30 were Malaysians and 20 were foreigners. The mean age of Malaysian patients was 58.3 ± 15.2 years whereas the mean age for foreign patients was 30.3 ± 6.7 years, with foreign patients being significantly younger than local patients. Foreigners had significantly smaller ulcers with only 5% of them having ulcers more than 1cm while 36.7% of Malaysian patients had ulcers more than 1cm. Post-operative complications are significantly higher in Malaysian patients (p<0.05) with 40% of Malaysian patients and 10% of foreign patients developing post-operative complications.. Foreign patients are younger with significantly smaller perforated ulcers and better post-operative outcomes.

Topics: Adult; Aged; Emergencies; Emigrants and Immigrants; Female; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer Perforation; Postoperative Complications; Retrospective Studies

Basal and pentagastrin stimulated acid output was measured in 80 normal and 179 duodenal ulcer subjects of Chinese, Indian and Malay origin. Basal and maximally stimulated acid output was significantly higher in duodenal ulcer patients compared with normal subjects. There was however considerable overlap and less than one in four duodenal ulcer patients were hypersecretors. The acid output (and hence the parietal cell mass) was lower than in Caucasian subjects and this was possibly related to weight differences. The acid output did not differ significantly in the Chinese, Indian and Malay subjects, suggesting that parietal cell mass in the three racial groups is closely similar. The difference in frequency of duodenal ulcer disease in the three racial groups is thus not related to gastric secretory capacity.

Topics: Adolescent; Adult; Age Factors; Aged; Asian People; Body Weight; Child; Duodenal Ulcer; Female; Gastric Acid; Gastric Acidity Determination; Humans; Malaysia; Male; Middle Aged; Parietal Cells, Gastric; Pentagastrin; Peptic Ulcer; Peptic Ulcer Perforation; Sex Factors; Singapore; White People

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Laparotomy; Malaysia; Male; Middle Aged; Peptic Ulcer Perforation

Topics: Adolescent; Adult; Duodenal Ulcer; Ethnicity; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Peptic Ulcer Perforation; Pneumoperitoneum; Postoperative Complications; Stomach Neoplasms; Stomach Rupture; Stomach Ulcer