Laparoscopic surgery to treat perforated gastric ulcer - duodenal bulb

The article is professionally consulted by Master, Doctor Nguyen Thai Binh - Gastroenterologist - Department of General Surgery - Vinmec Ha Long International General Hospital. The doctor has more than 20 years of experience working in the specialty of abdominal surgery.

Perforation of a peptic ulcer is a common acute complication of a peptic ulcer and is considered a form of emergency. Currently, surgery is the mainstay of treatment for this complication.

Perforated peptic ulcer is ranked 2nd - 4th in surgical emergencies after acute appendicitis, intestinal obstruction, and acute pancreatitis. Perforated gastric ulcer is a serious and serious complication of ulcer disease. If not diagnosed and treated promptly, this complication can be life-threatening.
According to the literature with statistics of many authors, patients with perforated peptic ulcers have late emergency surgery with a mortality rate of 2.5 - 10%. In elderly patients, the mortality rate is up to 30%.

Perforated peptic ulcer is common in any age group, from infants to the elderly 80-90 years old. It is most common in the working age group from 30 to 50 years old. The most notable is the perforation of peptic ulcer in young children. The majority of gastric perforation, duodenal bulb perforation are common in men (over 90%).

The principle of treatment is surgery as soon as possible. Patients who are operated on before 12 hours have a mortality rate from 0 to 0.5%, after 12 hours, the mortality rate is 15%. According to statistics of many authors, if surgery is delayed after 24 hours in elderly and frail patients, the mortality rate is up to 30%.
The purpose of surgery is to exclude and isolate the perforation, preventing digestive juices from draining into the abdomen. When conditions permit, it is possible to combine treatment of complications and radicalization.
Patient operated within 24 hours of perforation. The patient had no preoperative shock, no serious medical comorbidities. If the ulcer is bleeding at the edge of the perforation, the bleeding can be stopped endoscopically, then suture the perforation in 2 layers. With pyloric stenosis after suturing the perforation, nasogastric tube with balloon can be used to dilate the stricture or pyloroplasty to treat this complication.
If gastric cancer is suspected during laparoscopic surgery or if the abdominal cavity is dirty and difficult to clean, switch to open surgery. For perforation in the posterior duodenum or stomach, it is also advisable to convert to open surgery.

4.1 Contraindications of laparoscopic surgery The patient's condition is too weak, there are many co-morbidities. History of surgery for peritonitis, intestinal obstruction. Free ascites or focal ascites. Abdominal hernia, umbilical hernia. Local infection of the abdominal wall. Coagulation disorders. 4.2 Contraindications to intra-abdominal inflation Coronary heart disease Valve heart disease Chronic heart disease Post-operative care
Gastric tube is kept until the patient has a bowel movement, the time for nasogastric tube insertion is at least 48 hours . Resume feeding after removal of the nasogastric tube. Abdominal drainage, if present, is withdrawn when there is no more fluid, usually after 24 hours. Antibiotics are used according to the antibiotic treatment regimen, used for up to 5 days or until the fever is gone. Use drugs that reduce gastric secretion. Proton pump inhibitors or H2 receptor blockers are started immediately postoperatively. The patient got up and moved 24 hours after surgery. To accurately determine the health status, patients with one of the above signs should see a doctor. Vinmec International General Hospital with comprehensive expertise, services and facilities will help patients have a safe and comfortable experience when visiting Vinmec.