Need for pyloroplasty and vagotomy in case of perforated duodenal ulcer
PDF (Русский)
DOCX (Українська)

Keywords

duodenal ulcer, perforated duodenal ulcer, pylorostenosis, complications of peptic ulcer, surgical treatment

How to Cite

Podoluzhniy, V. I., Startsev, A. B., & Radionov, I. A. (2020). Need for pyloroplasty and vagotomy in case of perforated duodenal ulcer. Herald of Pancreatic Club, 46(1), 56-59. https://doi.org/10.33149/vkp.2020.01.07

Abstract views: 32
PDF Downloads: 5 PDF Downloads: 13

Abstract

Aim. Estimation of the incidence of stenosis, need for pyloroplasty and validity of vagotomy for perforated duodenal ulcer (PDU).

Materials and methods. Twenty-year nature of surgical treatment of patients with PDC in the hospital surgery clinic is analyzed.

Results. Over 20 years, 726 patients were operated on: 151 women (20.8%), 575 men (79.2%), mean age 39.1±6.3 years. Surgeries were performed both from laparotomic access and video laparoscopically. It is found that PDU is combined with stenosis in 8.5% and with bleeding in 1.6%, which requires Jadd excision of an ulcer on the anterior wall or gastroduodenotomy for flashing a bleeding ulcer on the posterior wall (0.7%) with subsequent Heineke — Mikulicz pyloroplasty and vagotomy. Both stem vagotomy and selective proximal were used by the method of skeletonization of lesser curvature or chemoneurolysis. Suturing with selective proximal vagotomy was performed in 567 patients, isolated suturing — in 77. B-II distal gastric resection was required in 2.1%. Repeated admission of patients with complications of a duodenal ulcer is observed after isolated suturing of PDU without surgical intervention in the mechanisms of ulcer formation.

Conclusion. During surgical treatment of PDU are found in 79.2% of men, in 20.8% of women. There is an emerging stenosis in 8.5% of those who have PDU, which requires a gastric drainage operation. The subjects of choice may be Heineke-Mikulicz pyloroplasty or Jadd excision of an ulcer on the anterior wall. It is advisable to suture or excise an ulcer with pyloroplasty accompanied by vagotomy that normalizes the acid-proteolytic activity of gastric juice in the postoperative period and eliminates need for antisecretory drugs to prevent the recurrence of the disease.

https://doi.org/10.33149/vkp.2020.01.07
PDF (Русский)
DOCX (Українська)

References

1. Авакимян В. А., Карапиди Г. К., Авакимян С. В., Алуханян О. А., Дидигов М. Т. Сочетание перфорации и кровотечения при язвенной болезни желудка и двенадцатиперстной кишки. Кубанский медицинский вестник. 2017. № 6. С. 7–11.
2. Афендулов С. А., Смирнов А. Д., Журавлев Г. Ю. Реабилитация больных после ушивания перфоративной язвы двенадцатиперстной кишки. Хирургия. 2002. № 4. С. 48–51.
3. Краснов О. А., Греков Д. Н., Подолужный В. И. Экспериментальное и клиническое обоснование применения 30% раствора этилового спирта для химической денервации кислотопродуцирующей зоны желудка. Вестник хирургии им. И. И. Грекова. 2007. № 5. С. 39–43.
4. Подолужный В. И., Иванов С. В., Греков Д. Н., Ооржак О. В. Прободная пилородуоденальная язва. Кемерово, 2014. 135 с.
5. Подолужный В. И. Современные представления о генезе, методах диагностики и хирургического лечения перфоративных язв двенадцатиперстной кишки. Фундаментальная и клиническая медицина. 2018. № 1. С. 73–79.
6. Bertleff M. J., Lange J. F. Perforated peptic ulcer disease: a review of history and treatment. Dig. Surg. 2010. Vol. 27, No 3. Р. 161–169.
7. Bornman C., Theodorou N. A., Jeffery P. C., Marks I. N., Essel H. P., Wright J. P. Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy. Br. J. Surg. 1990. Vol. 77, No 1. Р. 73–75.
8. Budzyński P., Pędziwiatr M., Grzesiak-Kuik A., Natkaniec M., Major P., Matłok M., Stanek M., Wierdak M., Migaczewski M., Pisarska M., Budzyński A. Changing patterns in the surgical treatment of perforated duodenal ulcer — single centre experience. Wideochir. Inne Tech. Maloinwazyjne. 2015. Vol. 10, No 3. Р. 430–436.
9. Chung K. T., Shelat V. G. Perforated peptic ulcer — an update. World J. Gastrointest. Surg. 2017. Vol. 9, No 1. Р. 1–12.
10. Gisbert J. P., Pajares J. M. Helicobacter pylori infection and perforated peptic ulcer prevalence of the infection and role of antimicrobial treatment. Helicobacter. 2003. Vol. 8, No 3. Р. 159–167.
11. Grišin E., Mikalauskas S., Poškus T., Йотаутас V., Strupas K. Laparoscopicpyloroplasty for perforated peptic ulcer. Wideochir. Inne Tech. Maloinwazyjne. 2017. Vol. 12, No 3. Р. 311–314.
12. Kamani F., Moghimi M., Marashi S. A., Peyrovi H., Sheikhvatan M. Perforated peptic ulcer disease: mid-term outcome among Iranian population. Turk. J. Gastroenterol. 2010. Vol. 21. Р. 125–128.
13. Lau J. Y., Sung J., Hill C., Henderson C., Howden C. W., Metz D. C. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011. Vol. 84, No 2. Р. 102–113.
14. Lau J. Y., Sung J., Hill C., Henderson C., Howden C. W., Metz D. C. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011. Vol. 84, No 2. Р. 102–113.
15. Rigopoulos A., Ramboiu S., Georgescu I. A critical evaluation of surgical treatment of perforated ulcer. Current Health Sciences Journal. 2011. Vol. 37, No 2. Р. 75–78.
16. Yang Y. J., Bang C. S., Shin S. P., Park T. Y., Suk K. T., Baik G. H. Clinical characteristics of peptic ulcer perforation in Korea. World J. Gastroenterol. 2017. Vol. 23, No 14. Р. 2566–2574.
17. Zelickson M. S., Bronder C. M., Johnson B. L., Camunas J. A., Smith D. E., Rawlinson D. Helicobacter pylori is not the predominant etiology for peptic ulcers requiring operation. Am. Surg. 2011. Vol. 77, No 8. Р. 1054–1060.