Surgical treatment of perforated gastric and duodenum ulcers complicated by diffuse peritonitis: prediction factors (part 2)

Sazhin A.V.; Ivakhov G.B.; Stradymov E.A.; Petukhov V.A.

doi:https://doi.org/10.17116/endoskop20192504146

Close metadata

Recommended articles:

Technical aspects of laparoscopic formation of gastroduodenoanastomosis (Billroth-I) during distal resection in patients with gastric cancer. Endoscopic Surgery. 2025;(3):44-51

Laparoscopic treatment of a patient with torsion of the wandering spleen. Endoscopic Surgery. 2025;(3):63-68

Surgical treatment of thoracic esophageal diverticula (clinical series). Russian Journal of Evidence-Based Gastroenterology. 2024;(4):89-94

The role of some inflammatory markers in diagnosis of acute peritonitis in patients with HIV infection. Pirogov Russian Journal of Surgery. 2024;(12):29-37

Immediate results of laparoscopic spleen-preserving distal pancreatectomy: Kimura vs Warshaw procedure. Pirogov Russian Journal of Surgery. 2025;(1):22-28

Pulmonary distress syndrome in urgent surgery: A concept, pathogenesis, and fundamentals of treatment. Pirogov Russian Journal of Surgery. 2025;(2):77-85

Laparoscopic interventions in urgent surgery (literature review). Pirogov Russian Journal of Surgery. 2025;(2):94-101

Fascial abdominal closure is a key factor of effective VAC-assisted laparostomy. Pirogov Russian Journal of Surgery. 2025;(4):61-70

Urogenital endometriosis. Russian Bulletin of Obstetrician-Gynecologist. 2025;(2):61-67

Posthysterectomy syndrome. Russian Bulletin of Obstetrician-Gynecologist. 2025;(3):34-40

Abstract:

For the objective outcome prognosis, the effect of some unfavorable factors on of the perforated peptic ulcers (PPU) surgical treatment were assessed, numerous clinical studies revised those had been carried out all around the world. In order to stratify patients with PPU in a high-risk group, it is accustomed to use various surgical and anesthesiological scales. The difficulty to define a uniform set of prognosticators is likely to attribute to the overall complexity of the disease and the number of factors involved. Some factors cannot be manipulated (e.g. age and gender) and the others are amenable to intervention (e.g. time before treatment; intensive care demand, concomitant diseases decompensation etc). Today there is no an «ideal» prognostic scale for the PPU. In this paper, the analysis was made of negative factors and different estimation scales of this disease, as well as the treatment algorithm for patients with PPU complicated by diffuse peritonitis was proposed. It is also logical to pointe it out the change of attitude to the concept of «conversion».

Keywords:

perforated ulcer

peritonitis

laparoscopy

scales

factors

conversion

Authors:

Sazhin A.V.

Pirogov Russian National Research Medical University

SPIN RSCI: 7064-6369
Scopus AuthorID: 6701753208
ORCID: 0000-0001-6188-6093

Ivakhov G.B.

Pirogov Russian National Research Medical University & ,V.S. Savel’ev University Faculty Clinic, Moscow, Russia

Stradymov E.A.

Pirogov Russian National Research Medical University & ,V.S. Savel’ev University Faculty Clinic, Moscow, Russia

SPIN RSCI: 1739-3002
ORCID: 0000-0001-9414-7588

Petukhov V.A.

Department of faculty surgery named after S.I. Spasokukotskyi, School of general medicine, Pirogov Russian National Research Medical University, Moscow, Russia

Close metadata

References:

Hermansson M, Staël von Holstein C, Zilling T. Surgical approach and prognostic factors after peptic ulcer perforation. Eur J Surg. 1999;165:566-572. https://doi.org/10.1080/110241599750006479
Rajesh V, Chandra SS, Smile SR. Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol. 2003;24:148-150.
Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today-indication, technique and outcome. Langenbecks Arch Surg. 2000;385:84-96. https://doi.org/10.1007/s004230050250
Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, Dolapci M, Cengiz O. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22:565-570. https://doi.org/10.1111/j.1440-1746.2006.04500.x
Blomgren LG. Perforated peptic ulcer: long-term results after simple closure in the elderly. World J Surg. 1997;21:412-414. https://doi.org/10.1007/PL00012263
Bulut OB, Rasmussen C, Fischer A. Acute surgical treatment of complicated peptic ulcers with special reference to the elderly. World J Surg. 1996;20:574-577. https://doi.org/10.1007/s002689900089
Svanes C, Salvesen H, Stangeland L, Svanes K, Søreide O. Perforated peptic ulcer over 56 years. Time trends in patients and disease characteristics. Gut. 1993;34:1666-1671. https://doi.org/10.1136/gut.34.12.1666
Sharma SS, Mamtani MR, Sharma MS, Kulkarni H. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer. BMC Surg. 2006;6:8. https://doi.org/10.1186/1471-2482-6-8
Thomsen RW, Riis A, Christensen S, Nørgaard M, Sørensen HT. Diabetes and 30-day mortality from peptic ulcer bleeding and perforation: a Danish population-based cohort study. Diabetes Care. 2006;29:805-810. https://doi.org/10.2337/diacare.29.04.06.dc05-1748
Søreide K, Thorsen K, Harrison EM, Bingener J, Møller MH, Ohene-Yeboah M, Søreide JA. Perforated peptic ulcer. Lancet. 2015;386(10000):1288-1298. https://doi.org/10.1016/S0140-6736(15)00276-7
Bucher P, Oulhaci W, Morel P, Ris F, Huber O. Results of conservative treatment for perforated gastroduodenal ulcer in patients not eligible for surgical repair. Swiss Med Wkly. 2007;137:337-340.
Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg. 1987;205:22-26.
Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Akahoshi K, Ayukawa K, Wada H, Tanoue K, Sugimachi K. The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age. Hepatogastroenterology. 2001;48:156-162.
Uccheddu A, Floris G, Altana M, Pisanu A, Cois A, Farci SL. Surgery for perforated peptic ulcer in the elderly. Evaluation of factors influencing prognosis. Hepatogastroenterology. 2003;50:1956-1958.
Siu W, Leong H, Law B, Chau CH, Li AC, Fung KH, Tai YP, Li MK. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235:313-319.
Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgeryfor perforated peptic ulcer. BJS. 2014;101:51-64.
Moller MH, Adamsen S, Thomsen RW. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg. 2011;98(6):802-810.
Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Ansaloni L, Bala M. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intraabdominal infections. World J Emerg Surg. 2017;12:36. https://doi.org/10.1186/s13017-017-0148-z
Udwadia TE. Diagnostic laparoscopy. A 30-year overview. Surg Endosc. 2004;18:6-10.
Vons C. Laparoscopy with a diagnostic aim in abdominal emergencies. Chirurgie. 1999;124(2):182-186.
Agresta F, Ciardo LF, Mazzarolo G, Michelet I, Orsi G, Trentin G, Bedin N. Peritonitis: laparoscopic approach. World J Emerg Surg. 2006;1:9. https://doi.org/10.1186/1749-7922-1-9
Agresta F, De Simone P, Bedin N. The Laparoscopic approach in abdominal emergencies. A single-center 10-year experience. JSLS. 200;8:25-30.
Agresta F, Michelet I, Colucci G, Bedin N. Emergency Laparoscopy. A community hospital experience. Surg Endosc. 2000;14:484-487.
Agresta F, Piazza A, Michelet I, Bedin N, Sartori CA. Small bowel obstruction. Laparoscopic approach. Surg Endosc. 2000;14:154-156.
Branicki FJ. Abdominal emergencies: diagnostic and therapeutic laparoscopy. Surg Infect (Larchmt). 2002;3(3):269-282.
Cuschieri A. Cost efficacy of laparoscopic vs open surgery. Surg Endosc. 1998;12:1197-1198.
Lau WY, Fan ST, Yiu TF, Chu KW, Suen HC, Wong KK. The clinical significance of routine histopathologic study of the resected appendix and safety of appendiceal inversion. Surg Gynaecol Obstet. 1986;162:256-258.
Sauerlenad S, Agresta F, Bergamaschi R, Borzellino G, Budzynsky A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA. Laparoscopic for abdominal emergencies: evidence based guidelines of the European Association for Endoscopic Surgery. Surg Endosc. 2006;20(1):14-29.
Salem TA, Molloy RG, O’Dwyer PJ. Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis. 2005;7(5):460-466.
Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013;21:25.
Knudsen NV, Møller MH. Association of mortality with out-of-hours admission in patients with perforated peptic ulcer. Acta Anaesthesiol Scand. 2015;59:248-254. https://doi.org/10.1111/aas.12450
Chung KT, Shelat VG. Perforated peptic ulcer — an update. World J Gastrointest Surg. 2017;9(1):1-12.
Moller MH, Engebjerg MC, Adamsen S, Bendix J, Thomsen RW. The peptic ulcer perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study. Acta Anaesthesiol Scand. 2012;56(5):655-662.
Mishra A, Sharma D, Raina VK. A simplified prognostic scoring system for peptic ulcer perforation in developing countries. Indian J Gastroenterol. 2003;22(2):49-53.
Altaca G, Sayek I, Onat D, Cakmakci M, Kamiloglu S. Risk factors in perforated peptic ulcer disease: comparison of a new score system with the Mannheim Peritonitis Index. Eur J Surg. 1992;158(4):217-221.
Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg. 2015;10:7. https://doi.org/10.1186/s13017-015-0008-7
Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281-284.
Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim Peritonitis Index. An instrument for the intraoperative prognosis of peritonitis. Chirurg. 1987;58:84-92.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-829. https://doi.org/10.1097/00003465-198603000-00013
Le Gall JR, Lemeshow S, Saulnier F. A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study. JAMA. 1993;270:2957-2963.
Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270(20):2478-2486.
Egberts JH, Summa B, Schulz U, Schafmayer C, Hinz S, Tepel J. Impact of preoperative physiological risk profile on postoperative morbidity and mortality after emergency operation of complicated peptic ulcer disease. World J Surg. 2007;31(7):1449-1457.
Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg. 2015;10:61. https://doi.org/10.1186/s13017-015-0055-0
Fitz-Henry J. The ASA classification and peri-operative risk. Ann R Coll Surg Engl. 2011;93:185-187. https://doi.org/10.1308/rcsann.2011.93.3.185a
Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ, Ju YT, Jeong CY, Ha WS. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26-35. https://doi.org/10.5230/jgc.2012.12.1.26
Boey J, Wong J, Ong GB. A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg. 1982;195(3):265-269.
Hemmer PH, de Schipper JS, van Etten B, Pierie JP, Bonenkamp JJ, de Graaf PW, Karsten TM. Results of surgery for perforated gastroduodenal ulcers in a Dutch population. Dig Surg. 2011;28(5-6):360-366.
Dorsett M, Kroll M, Smith CS, Asaro P, Liang SY, Moy HP. qSOFA Has Poor Sensitivity for Prehospital Identification of Severe Sepsis and Septic Shock. Prehosp Emerg Care. 2017;21(4):489-497. https://doi.org/10.1080/10903127.2016.1274348
Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg. 2014;18(7):1261-1268.
Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol. 2010;45:785-805. https://doi.org/10.3109/00365521003783320
Di Saverio S, Bassi M, Smerieri N, Masetti M, Ferrara F, Fabbri C, Ansaloni L, Ghersi S, Serenari M, Coccolini F, Naidoo N, Sartelli M, Tugnoli G, Catena F, Cennamo V, Jovine E. Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg. 2014;9:45. https://doi.org/10.1186/1749-7922-9-45
Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009;33(1):80-85.
Savel’ev VS, Gel’fand BR, Filimonov MI. Peritonitis. M.: Litterra; 2006. (In Russ.)
Muller MK, Wrann S, Widmer J, Klasen J, Weber M, Hahnloser D. Perforated Peptic Ulcer Repair: Factors Predicting Conversion in Laparoscopy and Postoperative Septic Complications. World J Surg. 2016;40(9):2186-2193. https://doi.org/10.1007/s00268-016-3516-z
Guadagni S, Cengeli I, Galatioto C, Furbetta N, Piero VL, Zocco G, Seccia M. Laparoscopic repair of perforated peptic ulcer: single-center result. Surg Endosc. 2014;28(8):2302-2308. https://doi.org/10.1007/s00464-014-3481-2
Evasovich MR, Clark TC, Horattas MC, Holda S, Treen L. Does pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc. 1996;10:1176-1179.
Siu WT, Chau CH, Law BKB, Tang CN, Ha PY, Li MKW. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg. 2004;91(4):481-484.
Angus DC, van der Poll T. Severe sepsis and septic shock. NEJM. 2013;369:840-851.
Weledji EP, Ngowe MN. The challenge of intra-abdominal sepsis. Int J Surg. 2013;11:290-295.
Sartelli M. Raising concerns about the Sepsis-3 definitions. World J Emerg Surg. 2018;13:6. https://doi.org/10.1186/s13017-018-0165-6
Sartelli M, Catena F, Di Saverio S. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9:22.
Singer M, Deutschman CS, Seymour CW. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-810.
Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AFT, Lipman J. Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection. Chest. 2017;151(3):586-596. https://doi.org/10.1016/j.chest.2016.10.057