RESUMEN
AIM: To compare laparoscopic and open closure of perforated peptic ulcer (PPU). MATERIAL AND METHODS: The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. RESULTS: Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. CONCLUSION: Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Laparoscopía , Laparotomía , Úlcera Péptica Perforada , Complicaciones Posoperatorias , Anciano , Investigación sobre la Eficacia Comparativa , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Úlcera Péptica Perforada/diagnóstico , Úlcera Péptica Perforada/cirugía , Atención Perioperativa/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Federación de Rusia , Técnicas de Cierre de Heridas/efectos adversosRESUMEN
The article outlines the morphologic evaluation of the gastric mucosa in 159 patients with different types of pyloroduodenal ulcers. The comparative characteristics of the gastric mucosa of 80 patients before and after the gastric resection. The complete restoration of the mucosa within the year after the selective proximal vagotomy was registered. The gastric resection leads to the chronic gastritis with dystrophic changes and intestinal or pseudopyloric metaplasia.
Asunto(s)
Úlcera Duodenal/patología , Gastrectomía/efectos adversos , Mucosa Gástrica/patología , Mucosa Gástrica/cirugía , Gastritis/etiología , Gastritis/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Úlcera Duodenal/cirugía , Femenino , Humanos , Masculino , Metaplasia , Persona de Mediana Edad , Píloro , Adulto JovenRESUMEN
The authors analyse the causes of 170 (38.3%) complications which occurred after 435 interventions for selective proximal vagotomy (SPV) with or without a stomach-draining operation. Specific complications were encountered in 31.9% and unspecific complications in 7.0% of cases. Intraoperative complications happened in 6 (3.6%) patients who had complications after vagotomy, early complications--in 54 (31.5%), and late complications--in 79 (46.8%) patients. The main causes of the specific complications were technical faults in performing SPV, disorder of gastric secretory, motor-evacuation, and barrier activity due to incomplete, inadequate vagotomy. Inadequate drainage and disorders of the immune system and dietary regimen, gastroduodenal reflux are conducive to the development of complications after SPV. Reconstructive-restorative operations and resection of the stomach are the operations of choice in organic complications after SPV and produce good late-term results.
Asunto(s)
Complicaciones Intraoperatorias , Vagotomía Gástrica Proximal/efectos adversos , Reflujo Duodenogástrico/complicaciones , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Gastropatías/complicaciones , Factores de TiempoRESUMEN
To evaluate the protective function of the gastric mucosa in 435 patients with pyloroduodenal ulcers, the authors applied the biochemical method for studying the gastric contents, which consisted of tests for the level of total glycoprotein and their fractions (hexoses, sialic acid) conducted before and after selective proximal vagotomy (SPV). The acid-secreting and neutralizing function of the stomach was appraised by the electrometric method, intragastric pH measurement. It was found that SPV produces a stable inhibiting effect on the acid-secreting function of the stomach in maintained protective function of the gastric mucosa, both in the immediate and in the long-term period. SPV has a favourable effect on the protective barrier of the gastric mucosa in the postoperative period.
Asunto(s)
Ácido Gástrico/metabolismo , Mucinas Gástricas/metabolismo , Mucosa Gástrica/metabolismo , Glicoproteínas/metabolismo , Úlcera Péptica/cirugía , Vagotomía Gástrica Proximal , Adolescente , Adulto , Anciano , Femenino , Mucinas Gástricas/fisiología , Glicoproteínas/fisiología , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Úlcera Péptica/fisiopatologíaRESUMEN
Selective proximal vagotomy (SPV) was performed in 435 patients whose age ranged from 16 to 80. The isolated variant of SPV was applied in 130 and SPV with a stomach draining operation was conducted in 305 patients; 320 patients were examined after the operation in follow-up periods of 7 years and more. Postoperative lethality was 0.6%. A recurrent ulcer was revealed in 4.3% of patients. The causes of the recurrence are indicated. The results were found to be excellent and good in 76%, satisfactory in 16.9%, and poor in 7.1% of the examined patients.