Complications of peptic ulcer disease in children and adolescents: minimally invasive treatments offer feasible surgical options.
OBJECTIVE
Surgery for complications of peptic ulcer disease (PUD) carries a significant morbidity and even mortality. The aim of this study was to determine the efficacy, safety, and outcome of children and adolescents undergoing minimally invasive treatment of bleeding and perforation complicating PUD.


METHODS
One hundred thirty-two consecutive patients aged 6 to 17 years managed endoscopically for bleeding and laparoscopically for perforation from January 1999 to February 2006 were reviewed.


RESULTS
Thirty children had significant endoscopic stigma of recent hemorrhage. Primary endoscopic hemostasis was achieved in most cases except one requiring further endoscopic hemostasis. Seventeen patients with perforation underwent laparoscopic patch repair. Four patients were converted to open repair because of technical difficulty and the large size of the ulcer. All patients had a course of proton pump inhibitors postoperatively. Ninety percent of patients had Helicobacter pylori infestation. Triple therapy was given. Two patients defaulted triple therapy and presented later with recurrent ulcer bleeding. All others remained asymptomatic on follow-up (average, 32.6 months).


CONCLUSIONS
Endoscopic hemostasis of bleeding peptic ulcer is effective and safe in children. With stringent criteria, laparoscopic patch repair of perforation can be applied safely to most pediatric patients. Eradication of H pylori and subsequent antiulcer medication are integral in the management of complicated PUD.
Wong
Beatrice P Y
BP
Division of Paediatric Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
Chao
Nicholas S Y
NS
Leung
Michael W Y
MW
Chung
Kwong-Wai
KW
Kwok
Wing-Kin
WK
Liu
Kelvin K W
KK
D000293:Adolescent; D002648:Child; D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010438:Peptic Ulcer Hemorrhage / Q000150:complications* / Q000209:etiology / Q000601:surgery*