OPTIMIZATION OF SURGICAL TREATMENT TACTICS IN PATIENTS WITH PERFORATED DUODENAL ULCER
Keywords:
Duodenal ulcer, ulcer perforation, surgical treatmentAbstract
The study included 234 patients with duodenal ulcer complicated by perforation. In patients with a predicted severe course of peritonitis, surgery in the volume of excision of an ulcer with pyloroplasty is optimal, in which the mortality rate is 17.8% less than when it is sutured with leveling of cases of suture failure (suture failure after suturing is 22.2%). The choice of a pathogenetically justified volume of primary surgery according to the proposed criteria allows to increase their volume by 18.7%, reduces the number of patients with pyloroduodenostenosis and ulcerative bleeding, reduces the number of relapses. The use of tactics for choosing the volume of primary surgery in patients with duodenal ulcer perforation, based on predicting the aggressiveness of the course of peritonitis, led to a statistically significant decrease in the mortality rate from 9.3% to 3.8% and postoperative complications from 12.3% to 2.9%.
References
Bae S.H., Yoon S.H., Cho Y., Park J.M. Predictive factors for postoperative morbidity and mortality after emergency surgery for perforated peptic ulcer disease. Journal of Gastrointestinal Surgery. 2019; 23(1): 103-111. DOI: 10.1007/s11605-018-3925-9.
Boey J., Wong J., Ong G.B. A prospective study of operative risk factors in perforated duodenal ulcers. Annals of Surgery. 2016; 194(3): 287-291. DOI: 10.1097/00000658-201609000-00009.
De Melo M.C., de Almeida G.S., de Lima T.L., Mesquita F.J. Prognostic factors in patients with peritonitis secondary to peptic ulcer perforation. Arquivos Brasileiros de Cirurgia Digestiva. 2017; 30(3): 157-161. DOI: 10.1590/0102-6720201700030015.
Gupta R., Yadav T.D., Verma G.R., Sharma N., Thakur A. Predictive scoring systems in perforation peritonitis: A study of 200 cases. International Journal of Surgery. 2018; 60: 81-85. DOI: 10.1016/j.ijsu.2018.11.022.
Lunevicius R., Morkevicius M. Risk factors influencing the early outcome in cases of perforated peptic ulcer. Scandinavian Journal of Surgery. 2018; 107(2): 130-137. DOI: 10.1177/1457496917749260.
Sahu S.K., Gupta P.K., Mishra S.K., Agrawal S. Scoring systems in perforation peritonitis. International Journal of Surgery. 2018; 57: 89-94. DOI: 10.1016/j.ijsu.2018.06.029.
Sоreide K., Thorsen K., Harrison E.M., Bingener J., Møller M.H. Management of perforated peptic ulcer in a multicenter cohort. The British Journal of Surgery. 2017; 104(6): 743-753. DOI: 10.1002/bjs.10448.
Thorsen K., Glomsaker T.B., von Meer A., Søreide J.A., Søreide K. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. Journal of Gastrointestinal Surgery. 2020; 24(4): 889-898. DOI: 10.1007/s11605-019-04436-5.
Tursunov O. M. et al. Interventional percutaneous technologies in the treatment of patients with obstructive jaundice syndrome // Journal of Biomedicine and Practice. – 2022. – T. 7. – No. 1
Wysocki A., Krzyżanowski P., Kosim A., Kulawik J., Szyca R. Risk factors for morbidity and mortality after emergency surgery for perforated peptic ulcer. Polish Journal of Surgery. 2018; 90(1): 5-10. DOI: 10.5604/01.3001.0012.0654.
Yeganeh M.A., Safari S., Ganji R., Sehat S., Kazemnejad E. Comparison of surgical techniques in the management of perforated duodenal ulcer. World Journal of Surgery. 2020; 44(9): 2935-2941. DOI: 10.1007/s00268-020-05516-8.
