[Perforated pyloric and prepyloric ulcers]

Various surgical interventions were conducted in the clinic on 63 patients for perforation of pyloric and prepyloric ulcers. Closure of the perforated ulcer was performed in 8 patients, excision of the ulcer and transverse pyloroplasty in 14, truncal and selective vagotomy in combination with antrumectomy in 6, and truncal vagotomy and pyloroplasty in 3 patients. According to the authors, the operation of choice is anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy and obligatory excision of the ulcer for histological study, and transverse pyloroplasty of the Aust-Holle type which was performed in 22 patients. The indications for radical operations were expanded bearing in mind the peculiarities of the course of peritonitis in patients with perforated gastric ulcers. In addition to the traditional prophylactic treatment of the abdominal cavity, the complex treatment of peritonitis included the use of low-frequency ultrasound during the operation and prolonged laparoscopic prophylactic treatment with low-intensity laser beam in the postoperative period.