ANALYSIS OF MODERN COMPLEX TREATMENT OF PATIENTS WITH PERFORATED GASTRODUODENAL ULCER

Abstract

Abstract. The goal is to improve the results of complex treatment of patients with a perforated gastroduodenal ulcer by analyzing the results of treatment using traditional surgical techniques and using minimally invasive, including endoscopic vacuum-associated (E-VAK) interventions. The results of treatment of 287 patients with gastric and duodenal ulcers complicated by perforation, who were treated in the surgical department of the city clinical emergency medical hospital during 2019-2023, were studied. Among gastric ulcers, chronic ulcers were found in 78 (27.2 %) cases, acute – in 34 (11.8 %) cases. There were 132 (46.0 %) chronic duodenal ulcers, 43 (15.0 %) acute ones. At the same time, in total, diagnostic laparoscopy was performed in 40 (13.9 %) patients, laparoscopic suturing of the perforating hole was performed in 32 (11.1 %) patients, and 8 (2.8 %) had indications for conversion. In 2 cases (0.69 %) endoscopic vacuum-associated (E-VAC) intervention was used for the treatment of duodenal ulcer perforation. 34 (11.8 %) patients underwent laparocentesis with subsequent drainage of the abdominal cavity and peritoneal lavage with decamethoxin solution before surgery. Among the complications in the postoperative period, failure of intestinal sutures was observed in 6 (2.1 %) patients. Postoperative mortality was 12.5 %. The cause of mortality in 27 (77.1 %) patients was the progression of multiple organ failure against the background of the terminal stage of peritonitis. Today, when choosing a method of treatment for a perforated gastroduodenal ulcer, preference should be given to minimally invasive laparoscopic methods before surgery with a laparotomy approach. The use of endoscopic vacuum-associated (E-VAK) interventions, especially in patients with IV-V degree of risk according to the ASA scale, is a promising direction in the treatment of patients with perforated gastroduodenal ulcer.