Abstract
Background
Repairing of a duodenal perforation is a well accepted procedure, but clinically, approximately 4% of patients develop duodenal leaks after perforation repair, increasing the risk of death. We retrospectively analyzed clinical data from 168 patients at our hospital to explore risk factors for duodenal leak after perforation repair and developed a nomogram for predicting postoperative duodenal leak.
Methods
This retrospective case–control study totalled 168 patients undergoing repair of a duodenal perforation with omentopexy at the General Surgery Department, Dongnan Hospital of **amen University, from January 2012 to January 2022. The patients were divided into the non-leak group and the leak group. Risk factors were evaluated by analyzing the patient’s sex, shock, diameter and anatomic position of the ulcer, use of NSAIDS and Glucocorticoid, history of drinking, diabetes, chronic diseases, age, time of onset of symptoms and lab tests.
Result
One hundred fifty-six patients (92.9%) who did not develop leaks after repair of a duodenal perforation were included in the non-leak group, and 12 (7.1%) developed leaks were included in the leak group. In univariate analysis, there were significant differences between the two groups referring to age, shock, NSAIDs, albumin, and perforation size (P < 0.05). The area under the ROC curve for perforation diameter was 0.737, the p-value was 0.006, the optimal cutoff point was 11.5, sensitivity was 58.3%, and specificity was 93.6%, the positive predictive value is 41.1%, and the negative predictive value is 98.0%. In the internal validation of the performance of the nomogram, the C-index and AUC of the model were 0.896(95%CI 0.81–0.98), demonstrating that the nomogram model was well calibrated.
Conclusion
The study discussed the risk factors for postoperative duodenal leak in patients undergoing repair of a duodenal perforation, and a nomogram was constructed to predict the leak. Future prospective studies with large sample sizes and multiple centres are needed to further elucidate the risk of duodenal leak after repair of a duodenal perforation.
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Background
Peptic ulcer disease is common, with a lifetime prevalence in the general population of about 5–10%, with an annual incidence of 0.1–0.3% [1]. The main clinical manifestations are abdominal pain, hematemesis, and black stools. Perforation, as a complication of peptic ulcer disease, is a well-known complication of surgical acute abdomen. The incidence rate in females is higher, and the perforation of peptic ulcers is most common in the duodenal bulb [2]. Peptic ulcer perforation(PUP) is the second most common ulcer complication after bleeding [3]. At the end of the last century and the beginning of this century, with the discovery of HP infection and the application of H2 receptor antagonists and proton pump inhibitors, it is no longer challenging to cure ulcers. Generally, an excellent therapeutic effect can be achieved after surgical intervention. Now, the first choice for PUP is simple perforation repair. Although the surgery is effective, this operation cannot cure ulcers. If no regular treatment is received after surgery, complications such as perforation and bleeding will still occur [4]. Clinically, placement of a drain near the duodenal repair or placement of a jejunal feeding tube may help to decrease the severity or development of a postoperative duodenal leak [5, 6].
Nevertheless, 4% of patients still suffer from the duodenal leak after perforation repair [7]. The primary manifestation is abdominal diffuse peritonitis which increases the risk of death. In this study, we analyzed the associated risk factors for postoperative duodenal leak and constructed a nomogram for predicting the leak.
Methods
Study design
This study is a retrospective analysis, and data were permitted by the Institutional Review Board of Dongnan Hospital of ** a duodenal leak after undergoing duodenal perforation repair. If the predicted probability of a leak is high, corresponding intervention measures such as intravenous supplementation of albumin, changing the surgical approach, placing a drain tube, and placing an enteral nutrition tube for early enteral nutrition may be necessary. These interventions can to some extent prevent the occurrence of postoperative leaks and improve the patient's postoperative recovery.
Availability of data and materials
The data sets generated and analyzed in this study are not publicly available due to potential invasion of personal privacy but are available from the corresponding author upon reasonable request.
Abbreviations
- NSAIDs:
-
Nonsteroidal anti-inflammatory drugs
- HP:
-
Helicobacter pylori
- PUP:
-
Peptic ulcer perforation
- CT:
-
Computed tomography
- HGB:
-
Hemoglobin
- ALB:
-
Albumin
- WBC:
-
White blood cell count
- PLT:
-
Platelet
- PPIs:
-
Proton pump inhibitors
- SD:
-
Standard deviation
- ROC:
-
Receiver operating characteristic curve
- AUC:
-
Area under the curve
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Acknowledgements
This study was not supported by any organization. The authors have no financial relationships that should be disclosed.
Funding
This research was supported by the Fujian Provincial Natural Science Foundation (2020J01133), and the granting organization had no involvement in this research.
Author information
Authors and Affiliations
Contributions
All authors contributed significantly to the design of the study. ZS collected and analyzed the data. LJP wrote the manuscript and performed the statistical analysis. XXJ substantively revised it. WSY supervised the writing of the paper and critically revised it for important intellectual content. All authors read and approved the final manuscript.
