[Fast track rehabilitation in perforated duodenal ulcer]. / Uskorennaia reabilitatsiia pri probodnoi iazve dvenadtsatiperstnoi kishki.

AIM: To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU). MATERIAL AND METHODS: For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period. RESULTS: In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days. CONCLUSION: Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

[A prospective randomized controlled trial of laparoscopic repair versus open repair for perforated peptic ulcers].

OBJECTIVE: To compared the clinical efficacy of laparoscopic repair (LR) versus open repair (OR) for perforated peptic ulcers. METHODS: From January 2010 to June 2014, in Shanghai Tongji Hospital, 119 patients who were diagnosed as perforated peptic ulcers and planned to receive operation were prospectively enrolled. Patients were randomly divided into LR (58 patients) and OR(61 patients) group by computer. Intra-operative and postoperative parameters were compared between two groups. This study was registered as a randomized controlled trial by the China Clinical Trials Registry (registration No.ChiCTR-TRC-11001607). RESULTS: There was no significant difference in baseline data between two groups (all P>0.05). No significant differences of operation time, morbidity of postoperative complication, mortality, reoperation probability, decompression time, fluid diet recovery time and hospitalization cost were found between two groups (all P>0.05). As compared to OR group, LR group required less postoperative fentanyl [(0.74±0.33) mg vs. (1.04±0.39) mg, t=-4.519, P=0.000] and had shorter hospital stay [median 7(5 to 9) days vs. 8(7 to 10) days, U=-2.090, P=0.001]. In LR group, 3 patients(5.2%) had leakage in perforation site after surgery. One case received laparotomy on the second day after surgery for diffuse peritonitis. The other two received conservative treatment (total parenteral nutrition and enteral nutrition). There was no recurrence of perforation in OR group. One patient of each group died of multiple organ dysfunction syndrome (MODS) 22 days after surgery. CONCLUSION: LR may be preferable for treating perforated peptic ulcers than OR, however preventive measures during LR should be taken to avoid postopertive leak in perforation site.

Systematic review comparing laparoscopic and open repair for perforated peptic ulcer.

BACKGROUND: The advantages of laparoscopic over open repair for perforated peptic ulcer are not as obvious as they may seem. This paper summarizes the published trials comparing the two approaches. METHODS: Two randomized prospective, five non-randomized prospective and eight retrospective studies were included in the analysis. Relevant trials were identified from the Medline/Pubmed database and the reference lists of the retrieved papers were then analysed. The outcome measures used were operating time, postoperative analgesic requirements, length of hospital stay, return to normal diet and usual activities, and complication and mortality rates. Published data were tested for heterogeneity by means of a chi2 test. Meta-analysis methods were used to measure the pooled estimate of the effect size. In total, 1113 patients are represented from 15 selected studies, of whom 535 were treated by laparoscopic repair and 578 by open repair; 102 patients (19.1 per cent) underwent conversion to open repair. RESULTS: Statistically significant findings in favour of laparoscopic repair were less analgesic use, shorter hospital stay, less wound infection and lower mortality rate. Shorter operating time and less suture-site leakage were advantages of open repair. Three variables (hospital stay, operating time and analgesic use) were significantly heterogeneous in the papers analysed. CONCLUSION: Laparoscopic repair seems better than open repair for low-risk patients. However, limited knowledge about its benefits and risks compared with open repair suggests that the latter, more familiar, approach may be more appropriate in high-risk patients. Further studies are needed.

[Experience with the early health resort rehabilitation of patients who have undergone a surgical intervention for peptic ulcer]. / Opyt rannei kurortnoi reabilitatsii bol'nykh, perenesshikh operativnoe vmeshatel'stvo po povodu iazvennoi bolezni.

The present article focuses on the analysis of results of health-resort rehabilitative treatment of 49 patients operated on for gastric and duodenal ulcer, in the early postoperative period (by day 20). The treatments were administered at the health-promotion centre Iuzhnyi [correction of "Yuzhny"] (Mirgorod), the Mirgorod mineral water having been taken as a basis of said treatment. A conclusion was reached to the effect that the optimum term for entering the patients into the rehabilitative project and ensuring their complication-free status is day 20 after the operation. This study addresses the issue of the effects Helicobacter pylori has on the inflammatory processes in the remaining portion of the stomach. The presence of Helicobacter pylori in the above portion of the stomach suggests it has no part in the etiology of its inflammatory processes.

[An individual approach to the surgical treatment and medical rehabilitation of duodenal ulcer patients]. / Individual'nyi podkhod k khirurgicheskomu lecheniiu i meditsinskoi reabilitatsii bol'nykh duodenal'noi iazvoi.

Since 1986 403 patients have been treated according to the following programme: successive preparation for surgery, the operative intervention chosen individually for each patient, the purposeful medical rehabilitation. Different types of vagotomy with draining operations were performed in 85.6% of the cases, stomach resection--in 14.4% of the patients. The mortality rate was 0%. The indications for various types of vagotomy, stomach resection and different types of draining operations were determined. Rehabilitation of 55% of the patients after the operative treatment took place at the gastroenterological department, the others--at an outpatient department. The indications for rehabilitation, its volume and time were established. The best remote results in the follow-up periods up to five years were obtained after truncal vagotomy and stomach resection. Ulcer recurrences were noted in 3.5% and 5.2% of the cases respectively. Recurrences of the disease were noted in 7.8% after combined vagotomy and in more than 20% after SPV. Nine patients out of 34 with recurrent ulcers were reoperated with good results, the others were successfully treated by conservative therapy.

[Patient rehabilitation following the surgical treatment of gastric and duodenal peptic ulcer]. / Reabilitatsiia bol'nykh posle khirurgicheskogo lecheniia iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

On the basis of observation of the ulcer disease of the stomach and duodenum in 970 patients given the restorative treatment in rehabilitation hospitals after being discharged from the surgical hospital the authors recommend the earlier rehabilitative treatment since it gives more rapid reestablishment of their working capacity.