Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer

Hung-Chieh Lo, Shih-Chi Wu, Hung-Chang Huang, Chun-Chieh Yeh, Jui-Chien Huang, Chi-Hsun Hsieh

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. Methods: From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. Results: Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. Conclusions: In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch. © 2011 Société Internationale de Chirurgie.
Original languageEnglish
Pages (from-to)1873-1878
Number of pages6
JournalWorld Journal of Surgery
Volume35
Issue number8
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Peptic Ulcer
Omentum
Peritonitis
Helicobacter pylori
Laparoscopy
Sutures
Ulcer
Shock
Length of Stay
Emergencies
Demography
Prospective Studies
Morbidity
Safety
Incidence

Keywords

  • adult
  • aged
  • anastomosis leakage
  • article
  • comparative study
  • duodenum ulcer
  • emergency
  • female
  • human
  • laparoscopy
  • male
  • methodology
  • middle aged
  • peritonitis
  • plastic surgery
  • postoperative complication
  • pylorus
  • retrospective study
  • risk factor
  • stomach ulcer
  • suturing method
  • ulcer perforation
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomotic Leak
  • Duodenal Ulcer
  • Emergencies
  • Female
  • Humans
  • Laparoscopy
  • Male
  • Middle Aged
  • Peptic Ulcer Perforation
  • Peritonitis
  • Postoperative Complications
  • Pylorus
  • Retrospective Studies
  • Risk Factors
  • Stomach Ulcer
  • Surgical Flaps
  • Suture Techniques
  • Young Adult

Cite this

Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer. / Lo, Hung-Chieh; Wu, Shih-Chi; Huang, Hung-Chang; Yeh, Chun-Chieh; Huang, Jui-Chien; Hsieh, Chi-Hsun.

In: World Journal of Surgery, Vol. 35, No. 8, 2011, p. 1873-1878.

Research output: Contribution to journalArticle

Lo, Hung-Chieh ; Wu, Shih-Chi ; Huang, Hung-Chang ; Yeh, Chun-Chieh ; Huang, Jui-Chien ; Hsieh, Chi-Hsun. / Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer. In: World Journal of Surgery. 2011 ; Vol. 35, No. 8. pp. 1873-1878.
@article{ce20570f4f944859b72ed69c530ab27d,
title = "Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer",
abstract = "Background: Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. Methods: From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. Results: Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. Conclusions: In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch. {\circledC} 2011 Soci{\'e}t{\'e} Internationale de Chirurgie.",
keywords = "adult, aged, anastomosis leakage, article, comparative study, duodenum ulcer, emergency, female, human, laparoscopy, male, methodology, middle aged, peritonitis, plastic surgery, postoperative complication, pylorus, retrospective study, risk factor, stomach ulcer, suturing method, ulcer perforation, Adult, Aged, Aged, 80 and over, Anastomotic Leak, Duodenal Ulcer, Emergencies, Female, Humans, Laparoscopy, Male, Middle Aged, Peptic Ulcer Perforation, Peritonitis, Postoperative Complications, Pylorus, Retrospective Studies, Risk Factors, Stomach Ulcer, Surgical Flaps, Suture Techniques, Young Adult",
author = "Hung-Chieh Lo and Shih-Chi Wu and Hung-Chang Huang and Chun-Chieh Yeh and Jui-Chien Huang and Chi-Hsun Hsieh",
note = "被引用次數:14 Export Date: 24 March 2016 CODEN: WJSUD 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, No. 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: hsiehchihsun@yahoo.com.tw 參考文獻: Hopkins, R.J., Girardi, L.S., Turney, E.A., Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: A review (1996) Gastroenterology, 110 (4), pp. 1244-1252. , DOI 10.1053/gast.1996.v110.pm8613015; Lam, S.K., Byth, K., Ng, M.M., Perforated peptic ulcer in Hong Kong and New South Wales (1992) J Gastroenterol Hepatol, 7, pp. 508-511. , 1391732 10.1111/j.1440-1746.1992.tb01029.x 1:STN:280: DyaK3s{\%}2FgsVChtQ{\%}3D{\%}3D; Canoy, D.S., Hart, A.R., Todd, C.J., Epidemiology of duodenal ulcer perforation: A study on hospital admissions in Norfolk, United Kingdom (2002) Digestive and Liver Disease, 34 (5), pp. 322-327. , DOI 10.1016/S1590-8658(02)80124-4; Darzi, A., Cheshire, N.J., Somers, S.S., Super, P.A., Guillou, P.J., Monson, J.R.T., Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler (1993) British Journal of Surgery, 80 (12), p. 1552. , DOI 10.1002/bjs.1800801221; Costalat, G., Dravet, F., Noel, P., Coelioscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (1991) Surg Endosc, 5, pp. 154-155. , 1837189 10.1007/BF02653225 1:STN:280:DyaK387gvVGksw{\%}3D{\%}3D; Pescatore, P., Halkic, N., Calmes, J.-M., Blum, A., Gillet, M., Combined laparoscopic-endoscopic method using an omental plug for therapy of gastroduodenal ulcer perforation (1998) Gastrointestinal Endoscopy, 48 (4), pp. 411-414. , DOI 10.1016/S0016-5107(98)70013-6; Nathanson, L.K., Easter, D.W., Cuschieri, A., Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer (1990) Surg Endosc, 4, pp. 232-233. , 2149782 10.1007/BF00316801 1:STN:280:DyaK3M7ltVShsg{\%}3D{\%}3D; Lau, H., Laparoscopic repair of perforated peptic ulcer: A meta-analysis (2004) Surgical Endoscopy, 18 (7), pp. 1013-1021; Boey, J., Choi, S.K.Y., Poon, A., Alagaratnam, T.T., Risk stratification in perforated duodenal ulcers: A prospective validation of predictive factors (1987) Annals of Surgery, 205 (1), pp. 22-26; Billing, A., Frohlich, D., Schildberg, F.W., Prediction of outcome using the Mannheim peritonitis index in 2003 patients (1994) British Journal of Surgery, 81 (2), pp. 209-213; Chung, S.C., Li, A.K., Helicobacter pylori and peptic ulcer surgery (1997) Br J Surg, 84, pp. 1489-1490. , 9393265 10.1002/bjs.1800841102 1:STN:280:DyaK1c{\%}2FlsV2ktw{\%}3D{\%}3D; Walt, R., Katschinski, B., Logan, R., Rising frequency of ulcer perforation in elderly people in the United Kingdom (1986) Lancet, 1 (8479), pp. 489-492; Ng, E.K.W., Lam, Y.H., Sung, J.J.Y., Yung, M.Y., To, K.F., Chan, A.C.W., Lee, D.W.H., Chung, S.C.S., Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation. Randomized controlled trial (2000) Annals of Surgery, 231 (2), pp. 153-158. , DOI 10.1097/00000658-200002000-00001; Bliss, D.W., Stabile, B.E., The impact of ulcerogenic drugs on surgery for the treatment of peptic ulcer disease (1991) Arch Surg, 126, pp. 609-612. , 1673597 1:STN:280:DyaK3M3hsVansQ{\%}3D{\%}3D; Gunshefski, L., Flancbaum, L., Brolin, R.E., Frankel, A., Changing patterns in perforated peptic ulcer disease (1990) American Surgeon, 56 (4), pp. 270-274; Linder, M.M., Wacha, H., Feldmann, U., The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis (1987) Chirurg, 58, pp. 84-92. , 3568820 1:STN:280:DyaL2s7ovFeiug{\%}3D{\%}3D; Lee, F.Y.J., Ka Lau Leung, Lai, B.S.P., Ng, S.S.M., Dexter, S., Wan Yee Lau, Predicting mortality and morbidity of patients operated on for perforated peptic ulcers (2001) Archives of Surgery, 136 (1), pp. 90-94; Lee, F.Y.J., Leung, K.L., Lai, P.B.S., Lau, J.W.Y., Selection of patients for laparoscopic repair of perforated peptic ulcer (2001) British Journal of Surgery, 88 (1), pp. 133-136. , DOI 10.1046/j.1365-2168.2001.01642.x; Lau, W.-Y., Leung, K.-L., Kwong, K.-H., Davey, I.C., Robertson, C., Dawson, J.J.W., Chung, S.C.S., Li, A.K.C., A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique (1996) Annals of Surgery, 224 (2), pp. 131-138. , DOI 10.1097/00000658-199608000-00004; Siu, W.T., Leong, H.T., Li, M.K.W., Single stitch laparoscopic omental patch repair of perforated peptic ulcer (1997) Journal of the Royal College of Surgeons of Edinburgh, 42 (2), pp. 92-94; Siu, W.T., Leong, H.T., Law, B.K.B., Chau, C.H., Li, A.C.N., Fung, K.H., Tai, Y.P., Li, M.K.W., Laparoscopic repair for perforated peptic ulcer: A randomized controlled trial (2002) Annals of Surgery, 235 (3), pp. 313-319. , DOI 10.1097/00000658-200203000-00001; Wong, D.C.T., Siu, W.T., Wong, S.K.H., Routine laparoscopic single-stitch omental patch repair for perforated peptic ulcer: Experience from 338 cases (2009) Surg Endosc, 23, pp. 457-458. , 19037692 10.1007/s00464-008-0215-3 1:STN:280:DC{\%}2BD1M{\%}2FoslGjsQ{\%}3D{\%}3D; Song, K.Y., Kim, T.H., Kim, S.N., Laparoscopic repair of perforated duodenal ulcers: The simple {"}one-stitch{"} suture with omental patch technique (2008) Surg Endosc, 22, pp. 1632-1635. , 18030520 10.1007/s00464-007-9670-5; Ates, M., Sevil, S., Bakircioglu, E., Colak, C., Laparoscopic repair of peptic ulcer perforation without omental patch versus conventional open repair (2007) Journal of Laparoendoscopic and Advanced Surgical Techniques, 17 (5), pp. 615-619. , DOI 10.1089/lap.2006.0195; Turner Jr., W.W., Thompson Jr., W.M., Thal, E.R., Perforated gastric ulcers. A plea for management by simple closures (1988) Arch Surg, 123, pp. 960-964. , 3395239; Lunevicius, R., Morkevicius, M., Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer (2005) World Journal of Surgery, 29 (10), pp. 1299-1310. , DOI 10.1007/s00268-005-7705-4",
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volume = "35",
pages = "1873--1878",
journal = "World Journal of Surgery",
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TY - JOUR

T1 - Laparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer

AU - Lo, Hung-Chieh

AU - Wu, Shih-Chi

AU - Huang, Hung-Chang

AU - Yeh, Chun-Chieh

AU - Huang, Jui-Chien

AU - Hsieh, Chi-Hsun

N1 - 被引用次數:14 Export Date: 24 March 2016 CODEN: WJSUD 通訊地址: Hsieh, C.-H.; Department of Trauma and Emergency Surgery, China Medical University Hospital, China Medical University, No. 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: hsiehchihsun@yahoo.com.tw 參考文獻: Hopkins, R.J., Girardi, L.S., Turney, E.A., Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: A review (1996) Gastroenterology, 110 (4), pp. 1244-1252. , DOI 10.1053/gast.1996.v110.pm8613015; Lam, S.K., Byth, K., Ng, M.M., Perforated peptic ulcer in Hong Kong and New South Wales (1992) J Gastroenterol Hepatol, 7, pp. 508-511. , 1391732 10.1111/j.1440-1746.1992.tb01029.x 1:STN:280: DyaK3s%2FgsVChtQ%3D%3D; Canoy, D.S., Hart, A.R., Todd, C.J., Epidemiology of duodenal ulcer perforation: A study on hospital admissions in Norfolk, United Kingdom (2002) Digestive and Liver Disease, 34 (5), pp. 322-327. , DOI 10.1016/S1590-8658(02)80124-4; Darzi, A., Cheshire, N.J., Somers, S.S., Super, P.A., Guillou, P.J., Monson, J.R.T., Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler (1993) British Journal of Surgery, 80 (12), p. 1552. , DOI 10.1002/bjs.1800801221; Costalat, G., Dravet, F., Noel, P., Coelioscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (1991) Surg Endosc, 5, pp. 154-155. , 1837189 10.1007/BF02653225 1:STN:280:DyaK387gvVGksw%3D%3D; Pescatore, P., Halkic, N., Calmes, J.-M., Blum, A., Gillet, M., Combined laparoscopic-endoscopic method using an omental plug for therapy of gastroduodenal ulcer perforation (1998) Gastrointestinal Endoscopy, 48 (4), pp. 411-414. , DOI 10.1016/S0016-5107(98)70013-6; Nathanson, L.K., Easter, D.W., Cuschieri, A., Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer (1990) Surg Endosc, 4, pp. 232-233. , 2149782 10.1007/BF00316801 1:STN:280:DyaK3M7ltVShsg%3D%3D; Lau, H., Laparoscopic repair of perforated peptic ulcer: A meta-analysis (2004) Surgical Endoscopy, 18 (7), pp. 1013-1021; Boey, J., Choi, S.K.Y., Poon, A., Alagaratnam, T.T., Risk stratification in perforated duodenal ulcers: A prospective validation of predictive factors (1987) Annals of Surgery, 205 (1), pp. 22-26; Billing, A., Frohlich, D., Schildberg, F.W., Prediction of outcome using the Mannheim peritonitis index in 2003 patients (1994) British Journal of Surgery, 81 (2), pp. 209-213; Chung, S.C., Li, A.K., Helicobacter pylori and peptic ulcer surgery (1997) Br J Surg, 84, pp. 1489-1490. , 9393265 10.1002/bjs.1800841102 1:STN:280:DyaK1c%2FlsV2ktw%3D%3D; Walt, R., Katschinski, B., Logan, R., Rising frequency of ulcer perforation in elderly people in the United Kingdom (1986) Lancet, 1 (8479), pp. 489-492; Ng, E.K.W., Lam, Y.H., Sung, J.J.Y., Yung, M.Y., To, K.F., Chan, A.C.W., Lee, D.W.H., Chung, S.C.S., Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation. Randomized controlled trial (2000) Annals of Surgery, 231 (2), pp. 153-158. , DOI 10.1097/00000658-200002000-00001; Bliss, D.W., Stabile, B.E., The impact of ulcerogenic drugs on surgery for the treatment of peptic ulcer disease (1991) Arch Surg, 126, pp. 609-612. , 1673597 1:STN:280:DyaK3M3hsVansQ%3D%3D; Gunshefski, L., Flancbaum, L., Brolin, R.E., Frankel, A., Changing patterns in perforated peptic ulcer disease (1990) American Surgeon, 56 (4), pp. 270-274; Linder, M.M., Wacha, H., Feldmann, U., The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis (1987) Chirurg, 58, pp. 84-92. , 3568820 1:STN:280:DyaL2s7ovFeiug%3D%3D; Lee, F.Y.J., Ka Lau Leung, Lai, B.S.P., Ng, S.S.M., Dexter, S., Wan Yee Lau, Predicting mortality and morbidity of patients operated on for perforated peptic ulcers (2001) Archives of Surgery, 136 (1), pp. 90-94; Lee, F.Y.J., Leung, K.L., Lai, P.B.S., Lau, J.W.Y., Selection of patients for laparoscopic repair of perforated peptic ulcer (2001) British Journal of Surgery, 88 (1), pp. 133-136. , DOI 10.1046/j.1365-2168.2001.01642.x; Lau, W.-Y., Leung, K.-L., Kwong, K.-H., Davey, I.C., Robertson, C., Dawson, J.J.W., Chung, S.C.S., Li, A.K.C., A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique (1996) Annals of Surgery, 224 (2), pp. 131-138. , DOI 10.1097/00000658-199608000-00004; Siu, W.T., Leong, H.T., Li, M.K.W., Single stitch laparoscopic omental patch repair of perforated peptic ulcer (1997) Journal of the Royal College of Surgeons of Edinburgh, 42 (2), pp. 92-94; Siu, W.T., Leong, H.T., Law, B.K.B., Chau, C.H., Li, A.C.N., Fung, K.H., Tai, Y.P., Li, M.K.W., Laparoscopic repair for perforated peptic ulcer: A randomized controlled trial (2002) Annals of Surgery, 235 (3), pp. 313-319. , DOI 10.1097/00000658-200203000-00001; Wong, D.C.T., Siu, W.T., Wong, S.K.H., Routine laparoscopic single-stitch omental patch repair for perforated peptic ulcer: Experience from 338 cases (2009) Surg Endosc, 23, pp. 457-458. , 19037692 10.1007/s00464-008-0215-3 1:STN:280:DC%2BD1M%2FoslGjsQ%3D%3D; Song, K.Y., Kim, T.H., Kim, S.N., Laparoscopic repair of perforated duodenal ulcers: The simple "one-stitch" suture with omental patch technique (2008) Surg Endosc, 22, pp. 1632-1635. , 18030520 10.1007/s00464-007-9670-5; Ates, M., Sevil, S., Bakircioglu, E., Colak, C., Laparoscopic repair of peptic ulcer perforation without omental patch versus conventional open repair (2007) Journal of Laparoendoscopic and Advanced Surgical Techniques, 17 (5), pp. 615-619. , DOI 10.1089/lap.2006.0195; Turner Jr., W.W., Thompson Jr., W.M., Thal, E.R., Perforated gastric ulcers. A plea for management by simple closures (1988) Arch Surg, 123, pp. 960-964. , 3395239; Lunevicius, R., Morkevicius, M., Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer (2005) World Journal of Surgery, 29 (10), pp. 1299-1310. , DOI 10.1007/s00268-005-7705-4

PY - 2011

Y1 - 2011

N2 - Background: Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. Methods: From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. Results: Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. Conclusions: In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch. © 2011 Société Internationale de Chirurgie.

AB - Background: Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. Methods: From July 2007 to August 2010, patients received emergency surgeries for PPU in our department were enrolled in this study. The demographic data, disease pattern, surgical outcomes were retrospectively collected. Patients who had previous multiple operations, with profound shock, and complicated ulcers were excluded. Results: Totally 73 patients were enrolled. 26 of them received simple closure and the other 47 received simple closure plus an omental patch. There were no difference in age, gender, ASA, Boey risk score, and incidence of co-morbidities. The Mannheim Peritonitis index, median operation time and length of stay were not different between groups. Conclusions: In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch. © 2011 Société Internationale de Chirurgie.

KW - adult

KW - aged

KW - anastomosis leakage

KW - article

KW - comparative study

KW - duodenum ulcer

KW - emergency

KW - female

KW - human

KW - laparoscopy

KW - male

KW - methodology

KW - middle aged

KW - peritonitis

KW - plastic surgery

KW - postoperative complication

KW - pylorus

KW - retrospective study

KW - risk factor

KW - stomach ulcer

KW - suturing method

KW - ulcer perforation

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anastomotic Leak

KW - Duodenal Ulcer

KW - Emergencies

KW - Female

KW - Humans

KW - Laparoscopy

KW - Male

KW - Middle Aged

KW - Peptic Ulcer Perforation

KW - Peritonitis

KW - Postoperative Complications

KW - Pylorus

KW - Retrospective Studies

KW - Risk Factors

KW - Stomach Ulcer

KW - Surgical Flaps

KW - Suture Techniques

KW - Young Adult

U2 - 10.1007/s00268-011-1106-7

DO - 10.1007/s00268-011-1106-7

M3 - Article

VL - 35

SP - 1873

EP - 1878

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 8

ER -