PERFORATED PEPTIC ULCERS

Two hundred forty-eight patients were operated for perforated peptic ulcer between 1983 and 1998. Of the patients 112 (45.1%) had chronic, 34 (13.7%) had acute ulcer history and 102 (41.2 %) had no ulcer history. Of the patients 228 (92.0%) had duodenal, 9 (3.6%) had juxtapyloric, 6 (2.4%) had marginal, and 5 (2.0%) had antral ulcer. Forty two patients (16.9%) admitted within 12 hours and 206 patients (83.1%) between 12 hours and six days after perforation. Simple closure and omental patch was performed in 32 patients (12.9%) who had severe concomitant illness and 126 (50.8%) intraabdominal sepsis, truncal vagotomi + pyloroplasty in 32 (12.9%), simple closure + omental patch + truncal vagotomi + gdstroenterostomy in 34 (13.7%), simple closures omental patch + pariatal cell vagotomy in 21 (8.5%), truncal vagotomi + antrectomy in 3 (1.2%). Patients who didn't have definitive procedure received H2 receptor blockers or proton pomp inhibitors. One hundred ninety-three patients (77.8%) underwent endoscopic control. Two of 53 patients with definitive procedure (3.8%) and 34 of 140 patients (24.3%) with simple closure had recurrence. Two patients in simple closure group underwent pariatal cell vagotomy, the others received medical treatment. The recurrence rate was significantly higher in simple closure group (p<0.01).

PEPTÝK ÜLSER PERFORASYONLARI

Peptik ülser perforasyonu nedeni ile 1983-1998 yýllarý arasýnda ameliyat edilen 248 hastanýn kayýtlarý retrospektif olarak incelendi. Hastalarýn 112'sinde (%45.1) kronik, 34'ünde (%13.7) akut ülser hikayesi varken, 102 hastada (%41.2) ülser hikayesi yoktu. Hastalarýn 228'inde (%92.0) duodenal, 9'unda (%3.6) jukstapilorik, 6'sýnda (%2.4) marjinal, 5'inde (%2.0) antral ülser mevcuttu. Hastalarýn 42'si (%16.9) semptomlarýn baþlamasýndan sonraki ilk 12 saat içinde hastaneye müracaat ederken 206'sý (%83.1) 12 saatten sonra (12 saat-6 gün) müracaat etti. Ýntraabdominal sepsis olan 126 hasta (%50.8) ile ciddi yandaþ hastalýðý olan 32 hastaya (%12.9) basit kapama+omentoplasti yapýlýrken, 32 hastaya (%12.9) bilateral trunkal vagotomi (BTV) + piloroplasti, 34 hastaya (%13.7) basit kapama + omentoplasti + BTV + gastroenterostomi, 21 hastaya (%8.5) basit kapama + omentoplasti +proksimal gastrik vagotomi (PGV), 3 hastaya (%1.2) BTV + antrektomi yapýldý. Definitif iþlem yapýlmayan hastalara H2 reseptör blokerleri veya proton pompa inhibitörleri verildi. Endoskopik kontrole 193 hasta (%77.8) geldi. Definitif iþlem yapýlýp kontrole gelen 53 hastanýn 2'sinde (%3.8) nüks tespit edildi ve bu hastalara medikal tedavi uygulandý. Definitif iþlem yapýlmayýp kontrole gelen 140 hastanýn 34'ünde (%24.3 nüks tespit edildi. Bu hastalarýn 2'sine definitif iþlem olarak PGV yapýlýrken diðerlerine medikal tedavi uygulandý. Nüks oraný definitif iþlem yapýlmayan hastalarda definitif iþlem yapýlanlardan anlamlý derecede yüksek olarak bulundu (p<0.01)