title: Treatment for perforated gastric ulcer: a multi-institutional retrospective review.
abstract: BACKGROUND
  The optimal treatment for patients with perforated gastric ulcer (PGU) remains controversial. This study therefore investigated the treatment status for this disease in clinical practice.
  
  
  METHODS
  We retrospectively reviewed 183 patients with PGU from 1998 to 2007 across 15 institutions, and analyzed patient characteristics and short- and long-term outcomes according to treatments received.
  
  
  RESULTS
  Of the 183 patients, 57 who were treated conservatively had less abdominal tenderness, lower levels of serum C-reactive protein, and shorter time to presentation than the 126 patients who underwent emergency surgery. There was no significant difference in baseline characteristics between the 41 successful patients and 16 failed patients in the conservative treatment group; however, the latter had a longer average hospital stay. Eighty-three of the emergency surgery patients who underwent gastrectomy had longer surgical times, greater blood loss, and shorter time to resumption of diet than the 57 patients undergoing stomach-preserving surgery; however, there was no significant difference in postoperative complications and hospital stay between these groups. Of 91 patients who received stomach-preserving treatment, only three had treatment failure in the long-term follow-up period.
  
  
  CONCLUSIONS
  Strictly selected patients should be initially considered for conservative treatment. The short-term outcomes of stomach-preserving surgery are comparable to gastrectomy; however, further evaluation of the long-term outcomes of stomach-preserving treatment is required.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-756 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Tanaka
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Kosugi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Yajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005743:Gastrectomy / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult