A perforated ulcer (PU) is a potentially lethal complication of peptic ulcer disease (PUD), with a mortality rate of up to 30%. The share of PU accounts for 2—20% of complications and up to 70% of the mortality associated with PUD.

OBJECTIVE

Improving the results of surgical treatment in patients with a perforated duodenal ulcer (PDU) by applying an enhanced rehabilitation program (ERP).

MATERIAL AND METHODS

A single-center prospective clinical study was conducted at the Department of Surgery and Endoscopy of the Pirogov Russian National Research Medical University, Moscow, Russia (V.M. Buyanov’s City Clinical Hospital, Moscow, Russia). From January 2015 to January 2020, the surgery results of 102 patients with PDU were analyzed.

RESULTS

Patients in both clinical groups were comparable in age, gender, duration of perforation, leukocytosis, values of prognostic scales of the American Association of Anaesthetists (ASA), J. Boey, mBoey, Peptic Ulcer Perforation Score (PULP) (p>0.05). There were no significant differences between the clinical groups in the prevalence and nature of peritonitis, operative time, DEP-classification points, the abdominal index, the Mannheim Peritoneal Index, the World Society of Emergency Surgery Sepsis Severity Score (WSES SSS) (p>0.05). In the main group, the length of stay was 3.86±1.14 (95% CI 3.53—4.18) days in the control group — 6.62±2.05 (95% CI 6.04—7.18) days (p<0.00001) with a comparable level of repeated hospitalizations: 2 (4.0%) in the main group and 1 (1.92%) — in the control group (p>0.05). Postoperative complications in the main group were detected in 4 cases (8.0%) and the control group — in 12 (23.09%) (p<0.05). There were no fatal outcomes in both clinical groups.

CONCLUSION

ERP in patients with PDU can significantly reduce the length of stay, and the number of postoperative complications promotes early and safe discharge of patients from the hospital.