Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study.

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Arroyo Vázquez, Jorge Alberto,1979Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery (författare)

Stent treatment or surgical closure for perforated duodenal ulcers: a prospective randomized study.

Artikel/kapitelEngelska2021

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2020-11-30
Springer Science and Business Media LLC,2021

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LIBRIS-ID:oai:gup.ub.gu.se/309537
https://gup.ub.gu.se/publication/309537URI
https://doi.org/10.1007/s00464-020-08158-3DOI

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Språk:engelska

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Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial.All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2-3weeks. Complications were recorded and classified according to Clavien-Dindo (C-D).43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5years (23-91) with no difference between groups. ASA score was unevenly distributed between the groups (p=0.069). Operation time was significantly shorter in the stent group, 68min (48-107) versus 92min (68-154) (p=0.001). Stents were removed after a median of 21days (11-37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2-5) (n.s.).Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng

Biuppslag (personer, institutioner, konferenser, titlar ...)

Khodakaram, Kaveh (författare)
Bergström, Maria,1964Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Extern,Institute of Clinical Sciences, Department of Surgery,External(Swepub:gu)xbergq (författare)
Park, Per-Ola,1950Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery(Swepub:gu)xparpe (författare)
Göteborgs universitetInstitutionen för kliniska vetenskaper, Avdelningen för kirurgi (creator_code:org_t)

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Ingår i:Surgical endoscopy: Springer Science and Business Media LLC35, s. 7183-71901432-22180930-2794

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Av författaren/redakt...: Arroyo Vázquez, ...; Khodakaram, Kave ...; Bergström, Maria ...; Park, Per-Ola, 1 ...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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