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Changing trend in emergency surgery for perforated duodenal ulcer.

OBJECTIVE
To evaluate changes in the emergency surgery of the duodenal ulcer.


DESIGN
Descriptive and analytical study.


PLACE AND DURATION OF STUDY
Department of Surgery, Haydarpasa Numune Teaching and Research Hospital. Data of peptic ulcer patients, operated on between January 1975 and the end of 1999, were collected between 1990 and 2000, and analysed retrospectively in the first half of 2003.


SUBJECTS AND METHODS
Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years (1975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods.


RESULTS
The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year.


CONCLUSION
Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medication in the recent years.