[Radical operative treatment of perforative gastroduodenal ulcer disease].
Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.
V K
VK
Gostishchev
M A
MA
Evseev
R A
RA
Golovin
D000328:Adult; D000465:Algorithms; D004630:Emergencies; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010439:Peptic Ulcer Perforation / Q000401:mortality / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D011178:Postgastrectomy Syndromes / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D016896:Treatment Outcome; D015167:Vagotomy, Truncal