Jorge A Arroyo Vàzquez, MD. South Alvsborg Hospital
Introduction: Standard treatment for perforated duodenal ulcer is surgery. We have used stent treatment in patients with high co-morbidity with good results. The aim of this study is to compare surgery with stent treatment for perforated duodenal ulcers in a randomized clinical trial. Here we present preliminary data from our ongoing trial sponsored by the SAGES foundation
Methods: All patients presenting at the ER with clinical signs of perforated duodenal ulcer and free abdominal air on a CT-scan, during December 2014 to August 2016, were asked to participate in the study. Treatment was randomized to sutured closure or stent treatment. Age, ASA-score, method of treatment, time to operation, operation time, complications and hospital stay were recorded.
Laparoscopy was performed in all patients to establish the diagnosis. Surgical closure was performed with standard open or laparoscopic techniques. For stent treatment a peroperative gastroscopy was performed and a partially covered duodenal stent (Hanaro, MI-tech) was placed over a guide-wire to cover the perforation. All patients received antibiotics and an abdominal drain was placed.
Results: 15 patients were randomized. Four patients did not have a duodenal perforation at laparoscopy and were excluded. 11 patients were included, 5 were treated with surgical closure and 6 with a duodenal stent. Median age was 75 y (23-89) in the surgical group and 81,5 y (73-87) in the stent group (non-significant). Median operation time was 96 min (82-137) for surgery and 67 min (60-107) for stent treatment, including laparoscopy (non-significant). The ASA-score was significantly higher in the stent group (median 3 (2-3)) vs surgery median 1 (1-4)) (p=0,01, C2 test). Median hospital stay was 7d (2-17) in the surgery group and 8d (3-24) in the stent group (non-significant). 2/5 patients in the surgical group had a complication, one patient had a suture-line leakage, treated with a duodenal stent and one had postoperative fever. In the stented group 2/6 patients had a complication, one intraabdominal abscess and one patient had multi-organ-failure and died on POD 1. This patients’ treatment had been delayed by several days. All patients with complications had >24 hours from symptom onset till time for laparoscopy.
Conclusions: These preliminary data indicate that stent treatment seems to be as safe and efficient as acute surgery for perforated duodenal ulcer with a tendency towards shorter operation time. The most important factor for a good outcome without complications seems to be the time factor from onset till treatment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79606
Program Number: P409
Presentation Session: Poster (Non CME)
Presentation Type: Poster