Yi Liang Wang, Xue Wei Chan, Kai Siang Chan*, Vishal G Shelat
Wang et al. J Clin Transl Res 2021; 7(6):14
Published online: November 29, 2021
Background and aim: Omental patch repair is the current gold-standard technique for patients with perforated peptic ulcers (PPU). Data are lacking regarding the safe ulcer size for omental patch repair leak (OPL). We analyse our experience in managing PPU to identify an ulcer size cut-off for predicting OPL.
Methods: Patients who had undergone omental patch repair for PPU between Jan 2004 and Apr 2016 were included. Demographic data, American Society of Anesthesiology (ASA) score, ulcer size, operative approach, postoperative complications, and length of stay were recorded. OPL, intra-abdominal collection, repeat surgery, and 30-day mortality were recorded. The relationship between ulcer size, preoperative characteristics, and OPL were investigated with univariate and multivariate logistic regression. Receiver operating characteristic curve (ROC) analysis derived the ulcer size cut-off to predict OPL. In addition, we analysed if ulcer size predicted mortality or malignancy.
Results: Six hundred ninety patients with a mean age of 55.1 years (range 16 – 94) were managed for PPU during the study period. Free air on X-ray was evident in 417 (60.4%) patients. Mean ulcer size was 7.8mm (range 1–50). OPL occurred in 15 patients (2.2%) and 30-day mortality was 7.4% (n=51). Multivariate analysis found ulcer size increase of 10mm (OR 3.30, 95% CI 1.81–6.02, p < 0.001) to predict OPL. At 25mm cut-off, sensitivity was 26.7%, specificity was 97.2%, positive likelihood ratio was 9.47 and negative likelihood ratio was 0.76 for OPL.
Conclusion: Ulcer size increase in 10mm increases leak rate by 3.3 times. Ulcer size ≥25mm predicts OPL.
Relevance for patients: Increased risk of OPL for ≥25mm warrants need for close post-operative monitoring and lowers threshold for investigations in event of clinical deterioration. Decision for omental patch repair versus gastrectomy however should not be based on ulcer size alone.
1. Department of General Surgery, Khoo Teck Puat Hospital, Singapore
2. Department of General Surgery, Tan Tock Seng Hospital, Singapore
Kai Siang Chan
Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China
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