Enhanced recovery pathways are now widely used in elective surgical procedures. The feasibility of enhanced postoperative recovery pathways in emergency surgery for perforated peptic ulcer disease was investigated in this randomized controlled clinical trial.
Patients with perforated peptic ulcer disease who underwent laparoscopic repair were randomized into 2 groups. Group 1 patients were managed with standard postoperative care and group 2 patients with enhanced postoperative recovery pathways. The primary endpoints were the length of hospital stay and morbidity and mortality.
Forty-seven patients were included in the study. There were 26 patients in group 1 and 21 in group 2. There were no significant differences in the morbidity and mortality rates, whereas the length of hospital stay was significantly shorter in group 2.
The application of enhanced postoperative recovery pathways in selected patients with perforated peptic ulcer disease who undergo laparoscopic Graham patch repair seems feasible.
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Published online: October 14, 2013
Received in revised form: July 12, 2013
Received: May 13, 2013
The authors declare no conflict of interest.
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Re: Gonenc M, Dural AC, Celik F, et al: Enhanced postoperative recovery pathways in emergency surgery: a randomized controlled clinical trialThe American Journal of SurgeryVol. 207Issue 6
- PreviewFirst suggested for patients with perforated gastric ulcers in 1894,1 omental patch closure of a perforated duodenal ulcer was popularized by Graham in 19372 and has remained a surgical mainstay. Over time and before the descriptions of Helicobacter pylori, H2-receptor antagonists, and proton-pump inhibitors, omental patch closure was one of the 4 operations used to treat perforated gastroduodenal ulcers. These included gastrectomy for perforated gastric ulcers and truncal vagotomy and pyloroplasty, truncal vagotomy and resection, and proximal gastric vagotomy with omental patch closure for perforated duodenal ulcers.
- Enhanced recovery in emergency surgery: validity and generalizability of a randomized trialThe American Journal of SurgeryVol. 210Issue 3
- PreviewI read with interest and anticipation the randomized trial on enhanced recovery after laparoscopic repair of perforated peptic ulcer (PPU).1 Strategies to improve outcomes in PPU are much needed.2 Although I do applaud the investigator’s effort in designing and performing an randomized controlled trial in emergency surgery (that, overall, are few and far between), I have some issues to share.