Background:
@EN Perforation of duodenal ulcer continues to be a major complication of ulcerating lesion of the duodenum and almost invariably produces a severe medical problem. There is worldwide agreement that perforated peptic ulcers in patients with high
surgical risk should be managed by the simplest and most effective procedure.
@ES Purpose:
@EN The aims of this study were to compare the morbidity and mortality related no operative procedures and to determine the risk factors for morbidity and mortality in perforated duodenal ulcer.
@ES patients and Methods:
@EN A total of 291 patients with perforated duodenal ulcer operated upon at the Department of Surgery, Dong Kang Hospital, Ulsan, between January 1985 and December 1994, were enrolled in this retrospective study.
Two hundred seventy cases were male, and 21 cases were female with a sex ratio of 12. 9:1. Age of patients ranged 15 to 84 years(median 37 years). Patients were divided into three groups: Gastrectomy group(n=172), vagotomy group(n=79) and simple
closure
group (n=40). Postoperative morbidity and mortality were analyzed and risk factors were determined by univariate chi-square analysis and multivariate stepwise logistic regression analysis. Statistical significance was considered for P<0.05.
@ES Results:
@EN Postoperative overall complication rate and mortality rate were 11.3% and 3.8%, respectively. Although complication rate was statistically out different between operative groups(P>0.1),however, mortality rate was highest in simple closure
group
(15%) compared with gastrectomy(2.9%) or vagotomy group (0%) (P<0.05).
By univariate analysis, age over 60years, female gender, time lag over 12 hours, preoperative shock, underlying disease, type of operation were identified as significant risk factors for morbidity or mortality. Of these factors, for morbidity -
time
lag, preoperative shock and underlying disease, and for mortality - preoperative shock and old age, were deter-mined as independent risk factors by multivariate analysis.
@ES Conclusion:
@EN We can conclude that although definitive ulcer surgery should be performed in low risk group of patients with perforated duodenal ulcer, however, intensive peri-operative care is mandatory in high risk group or patients, even if we select the
simple
closure.
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