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CHIRURGII OGÓLNEJ I NACZYNIOWEJ

Międzyleski Szpital Specjalistyczny w Warszawie


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LAPAROSCOPIC VERSUS OPEN PROCEDURE IN SURGICAL TREATMENT OF PERFORATED GASTRIC OR DUODENAL ULCER
Sławomir Poletajew1, Piotr Major2, Maciej Walędziak1, Maciej Staszak2, Magdalena Nowak1
Supervision: Tadeusz Mularczyk MD1, Maciej Matłok MD2

1Students’ Scientific Society for General and Vascular Surgery, Miedzyleski Specialist Hospital in Warsaw
Chief: Waldemar Kostewicz Ph MD

2Students’ Scientific Society at the 2nd Surgery Department, Jagiellonian University, Cracow
Chief: prof. Danuta Karcz


Peptic ulcer disease (PUD) is one of the most common pathologies of gastrointestinal tract. Perforation is a serious complication of PUD - being life-threatening condition, it requires surgical intervention. First open operations were performed in XIX century. Since 1990 laparoscopic procedure is an alternative for classic surgery in patients with perforated gastric or duodenal ulcer.

Aim
The aim of our study was to compare the procedures of open and laparoscopic suture of perforated ulcer of the stomach or duodenum.

Material and methods
The study was conducted retrospectively on 90 patients (25 female and 65 male ones, average age of 48,1) with diagnosed gastric or duodenal ulcer perforation. 37 patients were operated on in an open procedure in Miedzyleski Specialist Hospital in Warsaw and 53 patients were operated on in a laparoscopic procedure in the 2nd Surgery Department at the Jagiellonian University Collegium Medicum in Cracow.
Symptoms and localization of perforation were analysed. The groups were compared in terms of operating time, strict and liquid diet period, hospitalization period.

Results
The free air under a phrenic dome has been observed in 40% of patients. Pylorus was the most frequent localization of perforation in both groups (59%), with duodenal bulb on the second position (32%). Average time of laparoscopic and classic procedures were similar (75,3 vs 74,9 minutes; p>0,05). The group after the open operation started later with the liquid diet (3,1 vs 5,3 day; p<0,05) and with thebland diet (4,4 vs 6,0 day; p<0,05) than the group after the laparoscopic operation. Hospitalization period was shorter in laparoscopic group than in classic surgery one (7,8 vs 10,0 days; p<0,05).

Conclusions
Based on this study laparoscopic procedure can be assessed as a better than classic one for patients with perforated peptic ulcer. However, to evaluate definitive conclusion next studies are needed.
Therefore, experience of the surgeon and the surgical team should be always taken into consideration while choosing the adequate method.


PUBLIKACJA PRACY:
niebawem...

PREZENTACJA PRACY:
5th International Scienfitic Congress of Medical Students and Young Doctors. Warsaw, 25-27 April 2008.