Surgical Treatment of Perforated Duodenal Ulcer

Objective: This study aims to know which access is chosen to operate perforated duodenal ulcer and to evaluate the intra operative and postoperative complications.
Technique: Prospective analysis including all patients admitted with perforated duodenal ulcer. Open treatment is undertaken through midline laparotomy. Laparoscopic treatment is undertaken through 4 trocars. Suture of the ulcer, vagotomy or distal gastrectomy are proposed
Patients: Between 1997 and 2007, 97 patients were included. Diffused pain was found in 53.6% and diffused guarding in 69% of the cases. Ciruculatory failure was found in 34.6% of the cases. Surgery was undertaken under laparoscopy (56.7%), laparoscopy converted to laparotomy (7.2%), through midline laparotomy because of the condition of the patient (26.8%) and because it was the choice of the team (9.3%).
Results: During laparoscopy, 36.4% of the patients had risk factors. Ulcer was sutured in 94.5% of the cases. We observed 7.3% of intra operative complications, 5.5% of admittance in the intensive car unit, 16.7% of postoperative complications and 5.5% of reoperations. During laparotomy, 71.4% of the patients had risk factors. Ulcer was sutured (57.1%), obstructed with the umbilical ligament (2.3%), treated by vagotomy pyloroplasty (7.1%), by vagotomy seromyotomy (21.4%) or by distal gastrectomy (9.5%). We observed 11.9% of intra operative complications, 35.7% of admittance in the intensive car unit, 50% of postoperative complications, 14.3% of reoperations, and 26.2% of death.
Conclusion: Laparoscopy was undertaken in 56.7% of the cases with minimal risk. Because of associated risk factors and the importance of peritonitis, postoperative complications, reoperations and death were more frequent in the cases operated through laparotomy.

Session: Poster

Program Number: P243

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