Surgical Treatment of Perforated Duodenal Ulcer with The use of a Mini-Access

Abstract

The purpose of this study was to improve the immediate and long-term results of the surgical treatment of patients with perforated duodenal ulcer ulcer by excision of duodenal ulcer and duodenoplasty by using minimally invasive technologies. As research methods the following examinations were conducted: clinical and biochemical blood tests, abdominal radiography (for the presence of free gases in the abdominal cavity), ECG, FGDS followed by the repeated abdominal radiography, histological examination of biopsy material. On the operating table after the evacuation of gastric contents, gastric juice was taken through a probe, in which its volume (ml) and pH were determined. Intraoperative pH-metry was performed with pentagastrin stimulation (6 µg / kg). In the study of immediate and long-term results patients underwent a more thorough examination aimed at diagnosing postoperative complications and recurrence of the disease, identification of functional disorders. One considered the data of the patients’ complaints, fibrogastroduodenoscopy with biopsy, indicators of the secretory, motor-evacuation function of the stomach (X-ray examination). After discharge from the hospital the patient had to undergo a control examination after 6 months and 1 year after the surgery. In the long-term period (more than 1 year) the results were evaluated on the basis of a questionnaire based on Visic criteria inviting the patient for a follow-up examination at the clinic. To assess the well-being of the patient the questionnaire used the Visic classification in the modification of Yu. M. Pantsyrev with the division of the results into the following groups: excellent, good, satisfactory, unsatisfactory. The proposed video laparoscopic sanation and the use of excision of ulcers from small accesses with the implementation of duodenoplasty make it possible to: adequately sanitize the abdominal cavity, check the ulcer crater and establish the presence of stenosis and penetrating ulcer of the back duodenal wall, remove the inflammatory shaft around the ulcer, for better healing of the duodenal wound.