Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data

Introduction: Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these countries. This study describes surgical interventions for peptic ulcer disease in sub-Saharan Africa. Materials and Methods: A systematic review was performed using PubMed, EMBASE, and African Index Medicus for studies describing surgical management of peptic ulcer disease in sub-Saharan Africa. Results: From 55 published reports, 6594 patients underwent surgery for peptic ulcer disease. Most ulcers (86 %) were duodenal with the remainder gastric (14 %). Thirty-five percent of operations were performed for perforation, 7 % for bleeding, 30 % for obstruction, and 28 % for chronic disease. Common operations included vagotomy (60 %) and primary repair (31 %). The overall case fatality rate for peptic ulcer disease was 5.7 % and varied with indication for operation: 13.6 % for perforation, 11.5 % for bleeding, 0.5 % for obstruction, and 0.3 % for chronic disease. Conclusion: Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.