Perforated gastric and duodenal ulcers: treatment options

Abstract

This paper focuses on a prospective nonrandomized review of patients undergoing surgery for perforated gastric and duodenal ulcers. Patients and methods: A total of 198 patients with perforated gastric and duodenal ulcers were enrolled in the study between 2011 and 2016. The mean age of patients was 42 years. The disease was more common in men (87.3%) than in women (12.6%). The incidence of duodenal ulcer perforation was 86.3%. Anti-helicobacter therapy was administered to 33.8% of patients before perforation. In 5.6% of cases, recurrent ulcer perforation was established. The majority of patients (78.8 %) were admitted within the first 12 hours, while 7.5%-24 hours after perforation. The APACHE II scoring system was used to measure shock in 5.5% of cases. A score up to 6 was determined in 37.8% of patients, up to 12-in 47.9%, higher scores (more than 12) were measured in the remaining patients. Physical examination and diagnosis included clinical methods, abdominal X-ray, gastroduodenoscopy, ultrasound, laparoscopy, and the Boey risk scores. Results: Diagnostic laparoscopy was performed in 79.3% of patients, the diagnosis of concealed perforation was confirmed by gastroduodenoscopy. Video-assisted laparoscopy was performed in 59% of patients, 14.7%-underwent combined minimally invasive surgery (abdominal laparascopic examination and surgical intervention in the stomach or duodenum using a minimally invasive technique) and 26.3%-via laparotomy. Laparoscopic surgery was possible on the basis of gastroduodenoscopy, laparoscopy (perforation diameter, a correlation between the size of ulcer and perforation diameter, periulcerous infiltration sizes). Postoperative complications were recorded in 8.1% of cases, the mortality rate was 4.5%.