TMSS Medical College Journal

Introduction: Despite the introduction of histamine H2-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer objective perforation have increased'/ To improve the outcome of patients with PPU disease, A care protocol was applied causing significant reduction of the mortality rate from 27% to 17.1%". Methods: This is a hospital based interventional randomized control trial of patients with surgically treated PPU disease over a period of two years. Two series of patients group P (n=100) treated by perioperative care protocol and group C treated by hospital guided conventional operative management . Results: In group C patients underwent conventional operative management where operative mortality was 17% in comparison to group P Where patients were treated by care protocol and mortality rate was 7%. Conclusion: Mortality rate was reduced up to more than half after implementation of this care protocol compared to conventional treatment among the patients with PPU disease.

To improve the outcome of perforated peptic ulcer patients, it is necessary to investicate the reasons behind its high mortality rate’. Now-a days after the introduction of H, blockers and many PPI therapies, availability of endoscopes services has reduced successfully the surgical problems of duodenal ulcer disease, but perforation is still prevailing both in developed and developing world®. This increase has occurred despite improvements in perioperatrive treatment and monitoring. In this study we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable’. The outcomes of perforations have remained fairly unchanged. Even in recent reports, the mortality from perforated peptic ulcer (PPU) remains up to 27 % and complications are reported in 20-50 % of the patients. The operative mortality remains significantly high despite the improvement over the last several decades brought about by the advancements in surgical techniques, anesthesia, crtical care, a better understanding of the pathophysiology of the disease and the wide availability of antibiotics. To improve the outcome of patients with PPU, evidence based*'S perioperative care protocol is applied in various hospital in Denmark with significant reduction of the mortality rate from 27% to 17.1%. Recently, fast-track surgery and perioperative care protocols have gained popularity's. Quality of care for the management of PPU has been improved with documented reduction in morbidity and mortality rates among surgical patients’. This care protocol which is evidence-based applied before, during and after surgery were implemented for all patients with suspected perforated peptic ulcer disease. This protocol was implemented by the author with the help of professors, consultants, registrars, assistant registrars, trainee doctors, anesthesiologists, cardiologists, nurses of different divisions.