DIAGNOSIS AND TREATMENT ISSUES PERFORATIVE GASTRODUODENAL ULCER

Objective: To evaluate the effectiveness of treatment of patients with perforated gastroduodenal ulcers based on materials from the surgical departments of the «GK BSMP» healthcare institution in 2022-2023.

Material and methods. An analysis of the tactics and results of surgical treatment of 121 patients with this pathology was carried out. Of these: 82 men (67.8 %), 39 women (32.2 %) aged from 20 to 96 years. Upon admission to the clinic, patients underwent a plain radiography of the abdominal cavity. According to indications – esophagogastroduodenoscopy, repeated survey radiography of the abdominal cavity, computed tomography, laparoscopy. In the duodenum, the pathological process was localized in 104 patients (85.9 %), in the stomach – in 14 (11.6 %), in three (2.5 %) – in the area of gastroenteroanastomosis.

Results and its discussion. In the absence of a history of ulcers, the small size of the ulcer, its soft edges, symptoms of local peritonitis, and the absence of severe concomitant pathology, suturing of the perforation hole using the laparoscopic method was performed in 53 patients (43.8 %). Laparotomy and suturing of a perforated ulcer were performed in 21 patients (17.4 %); laparotomy, excision of ulcer according to Judd – 21 (17.4 %); laparotomy, excision of ulcer, transverse duodenoplasty – 17 patients (14.0 %). Excision of the perforated ulcer, extraduodenization, and transverse duodenoplasty were performed in 4 (3.3 %). When the process is located in the stomach, laparotomy, excision of the ulcer, and gastroplasty were performed in 4 cases (3.3 %), in 1 (0.8 %) – gastric resection according to Billroth-1, in 1 (0.8 %) – according to Billroth-1. 2 in the Hofmeister-Finsterer modification. 18 patients died (14.9 %). After laparotomy and suturing of the perforation – 12 (9.9 %). The most common direct cause of death was multiple organ failure syndrome – 13 (10.8 %).

Conclusion. The most frequently performed operation for perforated gastroduodenal ulcer in our clinic is currently laparoscopic suturing of the perforated hole – 53 (43.8 %). Patients experience a smooth course of the early postoperative period and no mortality.

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