Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Abstract

Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer. Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.