Novosti
Khirurgii

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Year 2019 Vol. 27 No 5

GENERAL & SPECIAL SURGERY

V.N. NIKITIN 1,, V.L. POLUEKTOV 1, S.G. KLIPACH 2, V.M. SITNIKOVA 1

DUODENOPLASTY FOR GIANT PERFORATED DUODENAL ULCER PENETRATING TO THE HEPATODUODENAL LIGAMENT

Omsk State Medical University 1,
Omsk Region Emergency City Clinical Hospital ¹2 2,
Omsk,
The Russian Federation

Objective. The development and introduction into clinical practice of a reliable method for radical duodenoplasty in the operations for the perforated giant duodenal ulcers penetrating into the hepatoduodenal ligament.
Methods. 15 patients with giant perforated duodenal ulcers were operated on. There were 13 men (86.7%) and 2 women (13.3%), the age varied from 51 to 81 years, the average age was 63.5+9.7 years. 4 (26.7%) patients were admitted two hours after the moment of perforation; in terms from 2 to 10 hours – 11 (73.3%). All 15 (100%) patients had ulcerative anamnesis from 2 to 35 years. Ulcer niches larger than 2.5 cm were referred to the giant perforated duodenal ulcers. The surgery volume was the following: the upper-median laparotomy, transverse duodenotomy through the perforated hole, exteriorization and treatment of ulcer crater, penetrating into the hepatoduodenal ligament; excision of the affected tissue of the duodenum anterior wall, the ulcer with the perforated hole, sewing the wound bowel duplex with a continuous suture. The results of treatment were evaluated by the surgery time terms, hospitalization terms, the number of complications and deaths, fibrogastroduodenoscopy (30 days and 1 year after surgery), indicators of life quality, according to the SF-36 questionnaire.
Results. The average duration of surgery was 78.0+10.5 minutes. Terms of hospitalization were from 11 to 17 bed-days, the average value – 13.3+2.1. Complications in the early postoperative period were the following: 2 cases of infected seroma of the postoperative scar and 1 case of the right lower lobe pneumonia. Suture failures in the sutured duodenal wound were not marked. Fibrogastroduodenoscopy revealed no ulcerative defects and severe deformation of the duodenal lumen in the duodenoplasty area.
Conclusions. The application of the proposed method of duodenoplasty with the use of two-layer continuous suture in case of giant perforated duodenal ulcers to minimize the likelihood of fatality due to failure of sutures is reproducible and can be used in clinical practice.

Keywords: giant duodenal ulcer, perforation, penetration, radical duodenoplasty, old age
p. 522-529 of the original issue
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    • Address for correspondence:
    644043, The Russian Federation,
    Omsk, Lenin Str., 12,
    Omsk State Medical University,
    Department of Faculty Surgery, Urology.
    Tel: +7 3812 35-91-30,
    e-mail: nikitin-1966@inbox.ru,
    Vyacheslav N. Nikitin
    Information about the authors:
    Nikitin Vyacheslav, PhD., Associate Professor of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-7250-9266
    Poluektov Vladimir, MD., Professor, Head of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-9395-5521
    Klipach Sergei, Head of the surgical unit, Region Emergency City Clinical Hospital ¹2, Omsk, Russian Federation.
    https://orcid.org/0000-0001-5679-6448
    Sitnikova Valentina, PhD., Assistant of the Department of Faculty Surgery, Urology, Omsk State Medical University, Omsk, Russian Federation.
    https://orcid.org/0000-0002-2239-6072
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