Yaroshuk D. Laparoscopic organ-preserving operations in the structure of a surgical correction of duodenal ulcer complicated by perforation

This scientific work is devoted to improving the results of a surgical treatment of patients with perforated duodenal ulcer (PDU) by means of enhance of the operational procedures and development of indications for applying pathogenetically grounded minimally invasive radical laparoscopic operations. 277 patients with PDU were examined and treated during a two-year prospective period: 251 (90.6 %) men and 26 (9.4 %) women, aged from 18 to 61 years. There are defined the risk factors of a relapse of peptic ulcer (PU) in patients after palliative open and laparoscopic surgeries. Patients belonging to a high risk group of a recurrence constitute 38.1 % of all patients with PDU . Two-years peptic ulcer recurrence rate after palliative and conditionally radical operations was significantly higher in such patients - 38.3 % in comparison with patients of a low-risk group -5.8 %. Conduction of the radical operations in patients with high risk of recurrence of peptic ulcer provides a steady decline of acidogenic gastric function and significantly better results rather than performing non-radical operations : the proportion of excellent and good results due to the Visik scale while their performance constitutes 83.5 % versus 52.3 %. Laparoscopic radical operations have lower pain intensity in the early postoperative period, an average period of peristalsis recovery, fewer bed-days in a hospital, a better cosmetic effect and the absence of postoperative ventral hernias. Conditions for performing laparoscopic operations in case of perforated duodenal ulcers exist in 47 % of patients. Treatment of such patients according to a respectively developed diagnostic - therapeutic algorithm, that takes into account a morphological substrate of the pathology, risk factors and peptic ulcer recurrence and envisages implementation of radical and non-radical laparoscopic surgeries, significantly improves short- and long-term results of curing the patients.