[The surgical treatment of patients with perforated stomach and duodenal ulcers]

An experience with surgical treatment of 1027 patients with perforated gastroduodenal ulcers was analyzed. Radical operations were performed on 541 patients (52.7%), palliative operations on 486 patients (47.3%). Total lethality was 7.5%, among them 13.2% after the palliative procedures, 2.4% after radical ones (p < 0.01). With all well-known risk factors (age older than 60 years, coexistent diseases, preoperative shock, time since the moment of perforation more than 24 hs, diffuse peritonitis etc.) the reliably lower lethality and less amount of early complications were noted after the bilateral truncal subdiaphragmatic vagotomy with dissection of the ulcer and pyloroplasty. The minimum volume of surgical interventions must be chosen in patients with critical general condition and terminal phase of intraperitoneal infection. Palliative operations (dissection and suture of the ulcer) are justified for perforating ulcers of the antral portion and body of the stomach against the background of risk factors.