Operations for perforation of duodenal ulcers and stomach
The most effective operation for the treatment of perforated duodenal ulcer is gastric resection. If its implementation is impossible due to the severe general condition of the patient with plp, significant contamination of the abdominal cavity, the operation of choice should be suturing of the perforated hole with omentoplasty. It was noticed that in 30-70% of patients who underwent this operation, the ulcer recurs, and in some cases, the perforation also recurs. However, it should be remembered that in 50–70% of patients, after suturing the perforation with omentoplast, a complete cure occurred. Currently, the percentage of patients cured should be higher due to the availability of effective antiulcer drugs.
Some surgeons perform stem or proximal gastric vagotomy in addition to suturing the perforation with omentoplasty. In the first case, it is necessary, if possible, to perform pyloroplasty or gastrojejunostomy. If the abdominal cavity is contaminated after vagotomy, there is a risk of mediastinitis. For this reason, in cases where gastric resection is indicated, the author prefers 70% Billroth II resection over hemigastrectomy with stem vagotomy to prevent possible mediastinal contamination. Gastric resection for perforated duodenal ulcers is usually easy to perform, since duodenal ulcers are usually located on the anterior intestinal wall.
For perforated anastomotic ulcers , simple suturing of the perforation should be performed. The final surgical treatment is carried out in the second stage if conservative therapy is unsuccessful.
Perforated stomach ulcer located in the middle third of the lesser curvature. The biopsy showed that the ulcer is benign. Due to the serious general condition of the patient, the perforation of the sommentoplasty was sutured. For this, you can use cotton, silk or non-absorbable synthetic threads.