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Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation

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Abstract

Background

There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes.

Methods

A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed. Data were obtained from seven Florida Hospital campuses. Patients aged 18 and older from 2006 to 2016 were identified by ICD9 billing information. Patients were divided into two groups: UGI and no UGI. The UGI group was subdivided into selective versus routine. A selective UGI was defined as one or more of the following after post-operative day 3: WBC >12,000, peritonitis, fever >100.4 F, tachycardia >110 bpm on three or more assessments, and any UGI performed after POD 7. Perioperative symptoms, perforation location, size, abdominal contamination, laparoscopic or open, leak detection, length of stay, mortality, and reoperation within 2 weeks were also examined.

Results

No differences between the UGI group and non-UGI group relating to preoperative symptoms, leak detection, death, and reoperation rate were revealed. Differences in length of stay were found to be statistically significant with the UGI group and non-UGI at a median of 15.5 and 8 days, respectively. In the UGI subgroup, 20 of the 29 patients received selective studies. There were no statistical differences identified in leak detection, death, and reoperation.

Conclusions

Rates of leak detection, reoperation, and death in patients with GP or DP repaired with omental patch utilizing an UGI study were not statistically significant. An increased length of stay was observed within the UGI group. There was no advantage demonstrated between a selective versus routine UGI; therefore, the use of selective UGI should be based upon clinical indications.

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Funding

No funding was obtained for this manuscript.

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Authors and Affiliations

  1. Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA

    Stephenie Poris, Paula Veldhuis, Yuan Du, Julie Pepe & Steve Eubanks

  2. University of Central Florida College of Medicine, Orlando, FL, USA

    Andrew Fontaine, Julie Glener & Stacey Kubovec

Authors
  1. Stephenie Poris
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  2. Andrew Fontaine
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  3. Julie Glener
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  4. Stacey Kubovec
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  5. Paula Veldhuis
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  6. Yuan Du
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  7. Julie Pepe
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  8. Steve Eubanks
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Corresponding author

Correspondence to Stephenie Poris.

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Disclosures

Stephenie Poris, Andrew. Fontaine, Julie Glener, Stacey Kubovec, Paula Veldhuis, Yuan Du, Julie Pepe, and Steve Eubanks have no conflicts of interest or financial ties to disclose.

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Poris, S., Fontaine, A., Glener, J. et al. Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation. Surg Endosc 32, 400–404 (2018). https://doi.org/10.1007/s00464-017-5695-6

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  • DOI: https://doi.org/10.1007/s00464-017-5695-6

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