title: Changing patterns in the surgical treatment of perforated duodenal ulcer - single centre experience.
abstract: BACKGROUND
  Although the surgical treatment of patients with perforated duodenal ulcer is the method of choice, the introduction of effective pharmacotherapy has changed the surgical strategy. Nowadays less extensive procedures are chosen more frequently. The introduction of laparoscopic procedures had a significant impact on treatment results.
  
  
  OBJECTIVE
  To present our experience in the treatment of perforated duodenal ulcer in two periods, by comparing open radical anti-ulcer procedures with laparoscopic ulcer repair.
  
  
  METHODS
  The analysis covered patients operated on for perforated duodenal ulcer. Two groups of patients were compared. Group 1 included 245 patients operated on in the period 1980-1994 with a traditional method (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). Group 2 included 106 patients treated in the period 2000-2014 with the laparoscopic technique supplemented with PPI therapy. Groups were compared in terms of patients' demographic structure, operative time, complication rate and mortality.
  
  
  RESULTS
  The mean operative time in group 1 was shorter than in group 2 (p < 0.0001). Complications were noted in 57 (23.3%) patients in group 1 and 14 (13.5%) patients in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In group 1, median length of hospital stay was 9 days and differed significantly from group 2 (6 days, p < 0.0001).
  
  
  CONCLUSIONS
  Within the last 30 years, significant changes in treatment of perforated peptic ulcer (PPU) have occurred, mainly related to abandoning routine radical anti-ulcer procedures and replacing the open technique with minimally invasive surgery. Thus it was possible to improve treatment results by reducing complication and mortality rates, and shortening the length of hospital stay. Although the laparoscopic operation is longer, it improves outcomes. In the authors' opinion, in each patient with suspected peptic ulcer perforation, laparoscopy should be the method of choice.
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Grzesiak-Kuik
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Stanek
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Wierdak
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pisarska
authors.affiliation: 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
keywords: duodenal ulcer; laparoscopic ulcer repair; laparoscopy; perforated peptic ulcer