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Khirurgii

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Year 2014 Vol. 22 No 3

GENERAL AND SPECIAL SURGERY

P.V. GARELIK, O.I. DUBROVCHIK, I.S. DOVNAR, I.T. TSILINDZ

PERFORATED GASTRODUODENAL ULCERS: A VIEW ON THE ISSUE OF CHOOSING A SPECIFIC SURGICAL APPROACH

EE “Grodno State Medical University”,
The Republic of Belarus

Objectives. To carry out a retrospective treatment analysis of patients operated on the perforated gastroduodenal ulcers.
Methods. Operative treatment results of 116 patients with perforated gastroduodenal ulcers during the period 2007-2013 yrs. have been investigated. The perforated ulcer localized in duodenum in 98 (84,5%) of patients; gastric ulcers – in 18 (15,5%). Repeated perforation of duodenal ulcer was presented in 4 patients (3,4 %). The peritonitis was presented in all cases: it was generalized in 82 (77,7 %) patients, local unlimited – in 28 (24,1 %), local limited – in 6 (5,2 %).
Results. The choice of a specific surgical approach at perforated ulcers was carried out on the basis of many factors: duration of ulcer anamnesis, results of conservative treatment, ulcer location, the form of peritonitis, accompanying diseases, etc. Suturing ulcer was performed in 73 (62,9%) cases. Sixty cases of perforations were located in the duodenum and only thirteen – in the stomach, 50 (43,1%) of them were operated laparoscopically. Excision of the perforated ulcer with pyloroplasty and truncal vagotomy was conducted in 38(30,2%) patients at the gastric/pyloric and duodenal ðerforation location. Judd pyloroplasty was added in 23 cases, Finney pyloroplasty – in 14, Heineke-Mikulicz pyloroplasty – in 1. Gastric resection was made in 5 (4,3%) patients with chronic callous gastric ulcers. Postoperative lethality rate was 2,6%.
Conclusions. The main method of surgical treatment of perforation is considered to be the suturing ulcers, which at present is mainly possible to be performed laparoscopically. It is possible to perform other surgical operations, but each of them must be carried out according to the strict indications.

Keywords: ulcer disease, perforated ulcers, laparoscopic ulcer closure, vagotomy, gastric resection
p. 321 – 325 of the original issue
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Address for correspondence:
220034, Respublika Belarus, g. Grodno, ul. Gorkogo, d. 80, UO «Grodnenskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: pethar@mail.ru,
Garelik Petr Vasilevich
Information about the authors:
Garelik P.V. MD, professor, a head of the general surgery chair, EE “Grodno State Medical University”.
Dubrovschik O.I. MD, professor of the general surgery chair, EE “Grodno State Medical University”.
Dovnar I.S. PhD, an associate professor of the general surgery chair, EE “Grodno State Medical University”.
Tsilindz I.T. PhD, an associate professor of the general surgery chair, EE “Grodno State Medical University”.
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