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BACKGROUND: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. METHOD: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. RESULTS: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. CONCLUSIONS: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.

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OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

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Resumen Introducción La perforación gastroduodenal continúa siendo una urgencia quirúrgica relativamente frecuente, a pesar de los avances realizados en el tratamiento médico de la enfermedad ulcerosa. Su abordaje laparoscópico ha ido aumentando en los últimos años, aunque no se ha generalizado. Nuestro objetivo es analizar los resultados postoperatorios en pacientes con úlcera perforada tratados mediante sutura laparoscópica, y compararlos con un grupo similar con sutura por laparotomía. Mantenemos la hipótesis de que la sutura laparoscópica es una opción segura y con menor morbilidad que el abordaje por laparotomía. Material y Métodos Análisis retrospectivo comparativo de dos cohortes de pacientes: una tratada mediante sutura laparoscópica durante los años 2014 y 2015, período en el que este abordaje estaba plenamente implantado en la Urgencia en nuestro hospital, y otro grupo comparable tratado mediante sutura por cirugía abierta durante el período 2001-2003. Se analizaron las complicaciones según la clasificación de Clavien-Dindo, tasa de conversión, estancia media y mortalidad. Resultados Los grupos eran comparables en edad, sexo, comorbilidades y riesgo anestésico. Se observó una tendencia a la superioridad a favor del abordaje laparoscópico en ciertas variables analizadas, con una tasa de conversión de un 3%. La presencia de complicaciones postoperatorias precoces fue mayor en el grupo con sutura por laparotomía: shock séptico postquirúrgico (15,2 % vs 6%) e infección de herida (15,2 % vs 3%), así como las complicaciones médicas, aunque de forma no significativa. El grupo tratado con sutura laparoscópica tuvo un mayor tiempo quirúrgico, menor estancia media y menor mortalidad. Conclusión La sutura laparoscópica de la úlcera gastroduodenal en nuestro centro ha tenido una baja tasa de conversión y una morbilidad algo menor a la sutura por laparotomía, con una menor tasa de reintervenciones y menor estancia media, a pesar de un mayor tiempo quirúrgico.

Introduction Gastroduodenal perforation continues to be a relatively frequent surgical emergency, despite advances in the medical treatment of ulcer disease. Its laparoscopic approach has been increasing in the last years, although it has not been generalized. Objective Was to analyze the postoperative results in patients with perforated ulcer treated with laparoscopic suture, and to compare them with a similar group with laparotomy suture. Our hypothesis was that laparoscopic suture is a safe option and with less morbidity than the laparotomy approach. Material and Methods Comparative retrospective analysis of two patient cohorts: one treated with laparoscopic suture during 2014 and 2015, a period in which this approach was fully implanted in the emergency room in our hospital, and another comparable group treated by suture for open surgery during the period 2001-2003. Complications were analyzed according to Clavien-Dindo classification, conversion rate, mean stay and mortality. Results The groups were comparable in age, sex, comorbidities and anesthetic risk. There was a trend towards superiority in favor of the laparoscopic approach in certain variables analyzed, with a conversion rate of 3%. The presence of early postoperative complications was greater in the laparotomy suture group: post-surgical septic shock (15.2% vs 6%) and wound infection (15.2% vs 3%), as well as medical complications, although not significantly. The group with laparoscopic suture had a longer surgical time, lower mean stay and lower mortality. Conclusion The laparoscopic suture of the gastroduodenal ulcer in our center has had a very low conversion rate and a somewhat lower morbidity to the laparotomy suture, with a lower rate of reinterventions and a mean stay, despite a longer surgical time.

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Introducción: la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior para erradicar el Helicobacter pylori, ha disminuido la recurrencia de la úlcera péptica, lo cual renueva el interés en este proceder ante las técnicas definitivas. Objetivos: determinar la eficacia a mediano plazo de este proceder en pacientes operados de úlcera péptica perforada. Métodos: se realizó un estudio observacional analítico en el Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2010 hasta diciembre de 2013. El estudio estuvo conformado por los pacientes operados de úlcera perforada con más de un año de evolución (45 casos). Los datos obtenidos se procesaron mediante el paquete estadístico SPSS para Windows versión 15.0, con técnica estadística de comparación de la prueba de hipótesis de proporciones en una computadora Pentium IV. Resultados: el sexo más afectado fue el masculino y predominó en la cuarta y quinta décadas de la vida. La localización más frecuente de la perforación fue duodenal y la mayoría, menores de 1 cm. Las complicaciones posoperatorias más frecuentes fueron las infecciones respiratorias. El tabaquismo y la ingestión de café fueron los factores de riesgo actuales más frecuentes. La mayoría de los pacientes recibieron tratamiento médico completo en el posoperatorio, con buenos resultados de acuerdo a la clasificación de Visick y en la endoscopia realizada, donde solo una paciente presentó enfermedad ulcerosa. Conclusiones: se comprobó que la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior completo es eficaz a mediano plazo(AU)

Introduction: suture and epiploplasty of perforated ulcer using further medical treatment for helicobacter pylori eradication has decreased recurrence of peptic ulcer, renewing interest in this proceeding in contrast to final techniques. Objective: determine the medium term efficacy of this procedure in patients undergoing surgery for perforated peptic ulcer. Methods: an observational study was conducted at Manuel Ascunce Domenech University Hospital in Camagüey, from January 2010 to December 2013. The study consisted of patients operated on for perforated ulcer over a year (45 cases). The obtained data were processed using SPSS for Windows version 15.0, with statistical technique of comparing the proportions hypothesis test on a Pentium IV computer. Results: the most affected patients were male aging forty and fifty. The most frequent location was duodenal perforation and most of them less than 1 cm. The most frequent postoperative complications were respiratory infections. Smoking habits and coffee intake were the most common risk factors. Most patients received full medical treatment in the postoperative period, with good results according to Visick classification and the endoscopy, where only one patient had ulcer disease. Conclusions: suture and perforated ulcer epiploplasty with subsequent full medical treatment, definitively, cure patients(AU)

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Introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. Material and Methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. Results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro-jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. Conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

Introducción: La perforación de una úlcera marginal es un evento grave que suele requerir una reoperación y se asocia a morbimortalidad. El manejo de estos pacientes es debatido y complejo. Objetivo: Describir una serie de pacientes operados de bypass gástrico laparoscópico (BPGLP) que evolucionaron con una úlcera marginal perforada. Material y Método: Se revisaron retrospectivamente las fichas de pacientes operados de BPGL los últimos 10 años y que evolucionaron con una úlcera marginal perforada. Se analizaron las características clínicas, de tratamiento y morbimortalidad perioperatoria. Resultados: Durante este período se operaron 2.095 pacientes de BPGLP, 12 de los cuales presentaron una úlcera marginal perforada, correspondientes a 10 mujeres y 2 hombres. El promedio de edad fue 39 años (21-60) y el índice de masa corporal (IMC) promedio al momento de la primera cirugía fue 34 (29,3-38,6). Diez pacientes tenían hábito tabáquico activo al momento de la perforación. La ocurrencia de esta sucedió en promedio a los 27 meses (rango 3-54, mediana 23,5) de la cirugía. En 11 casos la resolución fue quirúrgica, mediante abordaje laparoscópico en 9 y laparotomía en 2. En todos los casos se encontró una úlcera perforada en la vertiente yeyunal de la gastro-yeyuno anastomosis. No hubo mortalidad ni morbilidad asociada a la cirugía. Conclusiones: En nuestra experiencia la ocurrencia de úlcera marginal perforada post BPGLP se desarrolla en un bajo porcentaje de pacientes. El abordaje laparoscópico es de elección, presentando una baja morbimortalidad. El hábito tabáquico estuvo presente en la mayoría de los pacientes.

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Introduction: Surgical scores such as Boey and physiologic Portsmouth-POSSUM have been independently applied to patients with perforated ulcer to stratify their surgical risk. However, there are no studies comparing both scores. The purpose of this study was to compare the performance of Boey score and Portsmouth-POSSUM in patients with perforated peptic ulcer. Methods: A retrospective comparative study was performed including 108 consecutive patients older than 15-years submitted to emergency surgery from January 2002 to June 2012. Patients operated on for perforated gastric cancer were excluded. The primary outcome measure was to compare the performance of Portsmouth-POSSUM and Boey score. Secondary outcome measures were to determine cutoff points for Portsmouth-POSSUM, Boey score, C-reactive protein (CRP), and white blood cells (WBC) count, to predict patients at risk for complications. Results: The best cutoff point for CRP was 37.5 mg/l, and for WBC was 11.600 mm³ (OR 2.9 and 4.4). The best cutoff point for physiologic Portsmouth-POSSUM was 14, for surgical Portsmouth-POSSUM were 12, and for predictive Portsmouth-POSSUM was 0.8 percent. A time of perforation higher than 24 h had an OR of 35, and Boey score of 3 had an OR of 38.3. When Boey score was 2, with preoperative shock and time of perforation higher than 24 h being the positive variables, the OR was 194.3. Conclusions: Boey score performed better than Portsmouth-POSSUM, remaining a more specific score to stratify patients submitted to emergency surgery for perforated peptic ulcer.

Introducción: Puntuaciones pronósticas como la de Boey y el Portsmouth-POSSUM han sido utilizadas en pacientes con úlcera perforada para estratificar el riesgo quirúrgico. No existen estudios que comparen ambas puntuaciones. El objetivo del presente estudio es el de comparar el rendimiento de estas puntuaciones en pacientes con úlcera péptica perforada. Métodos: Se diseñó un estudio comparativo retrospectivo que incluyó 108 pacientes consecutivos mayores de 15 años sometidos a cirugía de urgencia entre enero de 2002 y junio de 2012. Se excluyeron pacientes operados por cáncer gástrico perforado. El objetivo principal fue comparar el rendimiento de la puntuación de Boey con Portsmouth-POSSUM. Los objetivos secundarios fueron determinar los puntos de corte para Portsmouth-POSSUM, puntuación de Boey, proteína C-reactiva (PCR) y recuento de leucocitos (RL) como factores predictivos de riesgo. Resultados: El mejor punto de corte para PCR fue 37,5 mg/l y para RL 11.600 mm³ (OR 2,9 y 4,4). El mejor punto de corte para Portsmouth-POSSUM fisiológico fue 14, para Portsmouth-POSSUM quirúrgico fue 12 y para Portsmouth-POSSUM predictivo fue 0,8 por ciento. Un tiempo de perforación mayor a 24 h tenía un OR de 35 y un puntaje de Boey de 3 tenía un OR de 38,3. Cuando el puntaje de Boey fue 2 con las variables choque preoperatorio y perforación mayor a 24 h, el OR fue 194,3. Conclusiones: La puntuación de Boey presentó mejor rendimiento que Portsmouth-POSSUM, representando una puntuación más específica para estratificar pacientes sometidos a cirugía de urgencia por úlcera perforada.

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