Postoperative anti-H. pylori therapy after laparoscopic repair for acute gastric ulcer perforation in elderly patients

BackgroundTo assess the clinical efficacy of laparoscopic gastric perforation repair combined with quadruple therapy for treating acute gastric ulcer perforation in the elderly.MethodClinical data of 92 elderly patients with acute gastric ulcer perforation admitted to our hospital from January 2019 to May 2023 were retrospectively collected. According to the treatment they received, patients were divided into a combination group and a control group, with 46 patients in each group. The control group underwent laparoscopic gastric perforation repair alone, whereas the combination group underwent laparoscopic gastric perforation repair followed by postoperative quadruple anti-Helicobacter pylori therapy. Serum inflammatory factors, gastric electrical parameters, serum motilin and gastrin levels, postoperative conditions, and adverse reactions during treatment were compared between the two groups before and after treatment. In addition, patients were followed up for 6 months after discharge, and long-term outcomes including ulcer recurrence, readmission, reoperation, and all-cause mortality were recorded.ResultsBefore treatment, IL-6, TNF-α, and hs-CRP levels were similar in both groups. Post-treatment, IL-6 levels in the combination group decreased to 11.89 ± 1.36 pg/mL compared to 16.23 ± 1.78 pg/mL in the control group (t = 13.14, p < 0.01); the mean difference was −4.34 (95% CI: 5.00 to −3.69), indicating a robust systemic anti-inflammatory effect. Gastric electrical parameters and serum gastrin and motilin levels increased in both groups, with better results in the combination group (p < 0.05). The overall complication rate during hospitalization was 4.35% (2/46) in the combination group versus 17.39% (8/46) in the control group (χ2 = 4.039, P = 0.044), with an odds ratio (OR) of 0.216 (95% CI: 0.043–1.082). At the 6-month follow-up, 43/46 patients in the combination group and 41/46 patients in the control group were successfully followed. The ulcer recurrence rate was 4.65% (2/43) in the combination group and 17.07% (7/41) in the control group; the readmission rate was 6.98% (3/43) and 19.51% (8/41), respectively; and the overall unfavorable follow-up outcome rate was 9.30% (4/43) and 26.83% (11/41), respectively (p < 0.05 for all).ConclusionThe results suggest that laparoscopic repair combined with quadruple therapy may effectively reduce inflammatory responses, improve gastrointestinal function, lower the incidence of early postoperative complications, and improve 6-month follow-up outcomes in elderly patients with acute gastric ulcer perforation. These findings provide a preliminary basis for the safety of this protocol in elderly patients, although validation through larger prospective randomized trials is required.