The place of minimally invasive technologies in the surgical treatment of perforated duodenal ulcer

M.I. Tutchenko, B.I. Slonetsky, I.V. Shcur, I.V. Verbitsky

Abstract


Background. The objective is to evaluate the effectiveness and feasibility of using minimally invasive technologies in the surgical treatment of perforated duodenal ulcer. Materials and methods. The results of diagnosis and treatment are analyzed in 124 patients with perforated duodenal ulcer, who were urgently hospitalized and were treated in surgical clinics of the Kyiv Municipal Clinical Emergency Hospital in 2016. In patients of the second (n = 36) group, unlike the first group (n = 88), the indications to the use of minimally invasive technologies were extended. Clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods; statistical methods of investigation were also used. Results. The results of the diagnosis and treatment of patients with perforated duodenal ulcer showed a significant predominance of male patients between the ages of 20 to 40 years, and only every twelve patient was of the elderly or senile age. The vast majority of patients (64.18 %) were hospitalized within the first six hours after the ulcer perforation, in most patients (76.24 %), the course of peritonitis on Mannheim Peritonitis Index was up to 21 points. Comprehensive application of instrumental methods allowed to determine the prime cause of the disease in 111 (89.52 %) cases, and their underestimation or severity of peritonitis became the basis for intraoperative diag­nosis in 11 (10.48 %) patients. Expanding indications to the use of minimally invasive technologies in patients of the second group, in contrast to the first group, allowed to perform laparoscopic duodenorrhaphy in half of the patients, laparoscopic duodenoplasty was performed in 5 (13.89 %) individuals and laparoscopic-assisted duodenoplasty — in 2 (5.56 %) patients. This was accompanied by a decrease in regional complications by 3.66 %, systemic complications — by 4.67 %, mortality — by 1.14 %, and the period of postoperative rehabilitation and social adaptation was significantly reduced. Conclusions. Instrumental verification of perforated duodenal ulcer made it possible to detect perforation in 70 (58.06 %) patients using only primary fluoroscopy, but the absence of its radiologic signs in case of failure to comply with the entire diagnostic measures in every tenth patient leads to intraoperative diagnosis. The use of emergency laparoscopy in patients of the second group with perforated duodenal ulcer allowed to perform laparoscopic duodenocorrection in 22 (61.11 %) patients, laparoscopic-assisted duodenocorrection — in 2 (5.56 %) persons, but every sixth (18.18) %) patient had a basis for perfor­ming surgical intervention through laparotomic access.

Keywords


duodenal ulcer; laparoscopy; acute surgical di­seases; gastrointestinal tract

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DOI: https://doi.org/10.22141/2224-0586.8.87.2017.121327

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