Choice of the operation for perforated ulcers of the stomach and duodenum

Actual questions of diagnostics and treatment of 776 patients with perforated gastroduodenal ulcers are discussed. The most informative method of the diagnosis, particularly covered perforation, is laparoscopy. Decision on the operation must be individually grounded. Radical operations were performed in 599 patients with 2% postoperative lethality. Lethality after suturing of the perforation was 10.3%, after resection operations--4.1%, after suturing the perforation in combination with selective proximal vagotomy--0.3%.     

Surgical treatment of combined ulcers of the stomach and duodenum

Under consideration were results of treatment of 71 patients with associated ulcers of the stomach and duodenum. Resection of the stomach was performed in 11 patients, various kinds of vagotomy--in 61 patients. Long-term results of operations in 69 patients were analyzed. Truncal vagotomy with an obligatory dissection of the gastric ulcer is a reliable method of treatment of the associated ulcers.     

Organ-sparing operations in bleeding ulcers of the pylorus and duodenum

The organ-preserving operations were performed in 387, gastric resection--in 142, closure or excision of an ulcer without vagotomy--in 132 patients with bleeding pyloroduodenal ulcers. The lethality after gastric resection was 11.3%: after the emergency operations--16.3%; after early elective interventions--9.1%; after the organ-preserving operations--2.6, 5.3, 0.85%, respectively.     

Multiple chronic stomach ulcers

The results of ambulatory endoscopic and clinical investigations performed in patients with multiple chronic gastric ulcers are analysed. It is established that the mentioned ulcers are characterized by the high incidence of reflux-esophagitis and inclination for bleeding. The operation of choice in multiple chronic ulcers is gastric resection, often atypical, stepped to preserve the reservoir function of the stomach.     

Diagnosis and surgical treatment of perforated ulcers of the stomach and duodenum

An analysis of treatment of 102 patients with perforated ulcers of the stomach and duodenum allowed to give a positive estimation of different combinations of subsidiary instrumental methods of examination (fibrogastroscopy, laparocentesis, fibrogastroscopy + laparocentesis etc.) in diagnosis of the disease. It was noted that these methods substantially improve the differential diagnostics and can be widely used in clinical practice.