OBJECTIVE OF THE STUDY: The sickness rate of perforated duodenal ulcer has been increasing in Russia during the last years. We used laparoscopic repair with individual study of an intragastric pH within 24 hours and rational therapy for low recurrence rate.
MATERIAL AND METHODS: The laparoscopic treatment of perforated duodenal ulcer was made to 136 patients.There were 131 male and 5 female and mean age was 36 years. Surgical procedure was: extensive lavage of abdominal cavity, extra-or intracorporeal suture repair and drainage. After procedure we conducted 24-hour monitoring of stomach acidity with 63 patients (46,3%). For examination purposes we use a daily computer-based acidogastromonitor
AGM 24MP “Gastroscan-24” since 1998. With the help of transnasal introduction of
three sensors of pH probe continuous registration of acid producing function changes of stomach is carried out at intervals of 20 seconds within 24 hours with the further data array transfer to a personal computer for study.
RESULTS: The test of medicamental vagotomy (atropine+benzohexoni) was negative in 38 patients (60,3%) . All patients have hyperacidity. 11 patients (17,5%) were found resistant to traditional therapy. Ranitidini was effective not more than 4 hours in 23 cases (36,5%). The intramuscular injection of histodili 2.0 ml was ineffective with 68% of patients. Histodili was effective not more than 1,5-3 hours in 32% cases. Famotidini was more effective than ranitidin by 1,5 times,
especially intravenous injection. HP–infection was study in 36 (57,1%) patients. 100% contamination of HP was revealed. The recurrence rate was 4,5% for patients with individual antiulcer therapy & HP eradication in the early postoperative period.
CONCLUSION: We consider that the laparoscopic repair of perforated duodenal ulcers is the method of choice with a further course of individually selected antiulcer treatment & HP eradication for low recurrence rate.
