Changing patterns in the surgical treatment of perforated duodenal XXXX - single centre experience.

@entity1 @entity1066
INTRODUCTION: Although the surgical treatment of @entity1 with perforated duodenal @entity1066 is the method of choice, the introduction of effective pharmacotherapy has changed the surgical strategy. Nowadays less extensive procedures are chosen more frequently. The introduction of laparoscopic procedures had a significant impact on treatment results. AIM: To present our experience in the treatment of perforated duodenal @entity1066 in two periods, by comparing open radical anti- @entity1066 procedures with laparoscopic @entity1066 repair. MATERIAL AND METHODS: The analysis covered @entity1 operated on for perforated duodenal @entity1066 . Two groups of @entity1 were compared. Group 1 included 245 @entity1 operated on in the period 1980-1994 with a traditional method (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). Group 2 included 106 @entity1 treated in the period 2000-2014 with the laparoscopic technique supplemented with PPI therapy. Groups were compared in terms of @entity1 ' demographic structure, operative time, complication rate and mortality. RESULTS: The mean operative time in group 1 was shorter than in group 2 (p < 0.0001). Complications were noted in 57 (23.3%) @entity1 in group 1 and 14 (13.5%) @entity1 in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In group 1, median length of hospital stay was 9 days and differed significantly from group 2 (6 days, p < 0.0001). CONCLUSIONS: Within the last 30 years, significant changes in treatment of perforated peptic @entity1066 (PPU) have occurred, mainly related to abandoning routine radical anti- @entity1066 procedures and replacing the open technique with minimally invasive surgery. Thus it was possible to improve treatment results by reducing complication and mortality rates, and shortening the length of hospital stay. Although the laparoscopic operation is longer, it improves outcomes. In the authors' opinion, in each @entity1 with suspected peptic @entity1066 perforation, laparoscopy should be the method of choice.
