DUODENOPLASTY FOR GIANT PERFORATED DUODENAL ULCER PENETRATING TO THE HEPATODUODENAL LIGAMENT
Objective. The development and introduction into clinical practice of a reliable method for radical duodenoplasty in the operations for the perforated giant duodenal ulcers penetrating into the hepatoduodenal ligament. Methods. 15 patients with giant perforated duodenal ulcers were operated on. There were 13 men (86.7%) and 2 women (13.3%), the age varied from 51 to 81 years, the average age was 63.5+9.7 years. 4 (26.7%) patients were admitted two hours after the moment of perforation; in terms from 2 to 10 hours - 11 (73.3%). All 15 (100%) patients had ulcerative anamnesis from 2 to 35 years. Ulcer niches larger than 2.5 cm were referred to the giant perforated duodenal ulcers. The surgery volume was the following: the upper-median laparotomy, transverse duodenotomy through the perforated hole, exteriorization and treatment of ulcer crater, penetrating into the hepatoduodenal ligament; excision of the affected tissue of the duodenum anterior wall, the ulcer with the perforated hole, sewing the wound bowel duplex with a continuous suture. The results of treatment were evaluated by the surgery time terms, hospitalization terms, the number of complications and deaths, fibrogastroduodenoscopy (30 days and 1 year after surgery), indicators of life quality, according to the SF-36 questionnaire. Results. The average duration of surgery was 78.0+10.5 minutes. Terms of hospitalization were from 11 to 17 bed-days, the average value - 13.3+2.1. Complications in the early postoperative period were the following: 2 cases of infected seroma of the postoperative scar and 1 case of the right lower lobe pneumonia. Suture failures in the sutured duodenal wound were not marked. Fibrogastroduodenoscopy revealed no ulcerative defects and severe deformation of the duodenal lumen in the duodenoplasty area. Conclusions. The application of the proposed method of duodenoplasty with the use of two-layer continuous suture in case of giant perforated duodenal ulcers to minimize the likelihood of fatality due to failure of sutures is reproducible and can be used in clinical practice. What this paper adds A method of radical duodenoplasty for the giant perforated duodenal ulcers penetrating into the hepatoduodenal ligament has been developed and introduced for the first time. It is distinguished by the innovative technology of dissecting the anterior wall of the duodenal bulb through the perforated hole and using a two-level continuous suture that does not penetrate the intestinal lumen. The absence of cases of sutures inconsistency in the sutured intestinal wound as well as any deformation of the intestinal lumen after surgery has been established.