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Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers.

Publication ,  Journal Article
Schroder, VT; Pappas, TN; Vaslef, SN; De La Fuente, SG; Scarborough, JE
Published in: Ann Surg
June 2014

OBJECTIVE: To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers. BACKGROUND: Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice. METHODS: A retrospective analysis of data for patients from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database who underwent emergency operation for bleeding or perforated peptic ulcer disease was performed to determine the association between surgical approach (local procedure alone, vagotomy/drainage, or vagotomy/gastric resection) and 30-day postoperative outcomes. Multivariable regression analysis was used to adjust for a number of patient-related factors. RESULTS: A total of 3611 patients undergoing emergency ulcer surgery (775 for bleeding, 2374 for perforation) were included for data analysis. Compared with patients undergoing local procedures alone, vagotomy/gastric resection was associated with significantly greater postoperative morbidity when performed for either ulcer perforation or bleeding. For patients with perforated ulcers, vagotomy/drainage produced similar outcomes as local procedures but required a significantly greater length of postoperative hospitalization. Conversely, vagotomy/drainage was associated with a significantly lower postoperative mortality rate than local ulcer oversew when performed for bleeding ulcers. CONCLUSIONS: Simple repair is the procedure of choice for patients requiring emergency surgery for perforated peptic ulcer disease. For patients requiring emergency operation for intractable ulcer bleeding, vagotomy/drainage is associated with lower postoperative mortality than with simple ulcer oversew.

Duke Scholars

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2014

Volume

259

Issue

6

Start / End Page

1111 / 1118

Location

United States

Related Subject Headings

  • Vagotomy
  • United States
  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Stomach Ulcer
  • Retrospective Studies
  • Postoperative Period
  • Peptic Ulcer Perforation
  • Peptic Ulcer Hemorrhage
 

Citation

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ICMJE
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Schroder, V. T., Pappas, T. N., Vaslef, S. N., De La Fuente, S. G., & Scarborough, J. E. (2014). Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg, 259(6), 1111–1118. https://doi.org/10.1097/SLA.0000000000000386
Schroder, Vanessa T., Theodore N. Pappas, Steven N. Vaslef, Sebastian G. De La Fuente, and John E. Scarborough. “Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers.Ann Surg 259, no. 6 (June 2014): 1111–18. https://doi.org/10.1097/SLA.0000000000000386.
Schroder VT, Pappas TN, Vaslef SN, De La Fuente SG, Scarborough JE. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014 Jun;259(6):1111–8.
Schroder, Vanessa T., et al. “Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers.Ann Surg, vol. 259, no. 6, June 2014, pp. 1111–18. Pubmed, doi:10.1097/SLA.0000000000000386.
Schroder VT, Pappas TN, Vaslef SN, De La Fuente SG, Scarborough JE. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014 Jun;259(6):1111–1118.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2014

Volume

259

Issue

6

Start / End Page

1111 / 1118

Location

United States

Related Subject Headings

  • Vagotomy
  • United States
  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Stomach Ulcer
  • Retrospective Studies
  • Postoperative Period
  • Peptic Ulcer Perforation
  • Peptic Ulcer Hemorrhage