title: Strategies to improve the outcome of emergency surgery for perforated peptic ulcer.
abstract: BACKGROUND
  Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed.
  
  
  METHODS
  PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred.
  
  
  RESULTS
  Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence.
  
  
  CONCLUSIONS
  Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies.
authors: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors: K
authors: K
authors: Søreide
authors: K
authors: K
authors: Thorsen
authors: J A
authors: JA
authors: Søreide
mesh_terms: D004381:Duodenal Ulcer / Q000175:diagnosis / Q000601:surgery*; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000401:mortality*; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013276:Stomach Ulcer / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome