Differentiated approach to surgical treatment of patients with perforated duodenal ulcer

From 1995-2001, 264 patients with perforated duodenal ulcer were treated by the Emergency Surgical Service of Azerbaijan State Medical University in Baku. In a time of evolving standards and scientific understanding of acid peptic disease, a treatment formula was applied with excellent results. Treatment was tailored to the stage of peritonitis by time from perforation. This time was objectively evaluated by analysis of the peritoneal exudate. The value of laparoscopy was also assessed. Simple closure was performed in 94 patients (open procedure in 46, laparoscopic suture of perforated ulcer in 48 patients). Resection was performed in 170 patients (partial gastrectomy Billroth I in 118 patients, partial gastrectomy Billroth II in 18 patients and antrectomy vagotomy in 34). Application of the algorithm reduced mortality after simple closure to 6.4% and after resection to 1.2%.