Running two-level suturing technique for perforated pyloroduodenal ulcers
Nikitin V.N¹., Klipach S.G<sup>.2

1</sup> Omsk State Medical University
² City Clinical Emergency Hospital, Omsk

Aim. To summarize clinical experience and to assess the outcomes of the suturing of perforated pyloroduodenal ulcer using running two-level technique.
Patients and methods. 159 patients who underwent surgery for perforated pyloroduodenal ulcer (2009−2016) were enrolled in the study. Study group included 79 patients who underwent the suturing of the ulcer using running two-level technique without capturing the mucosa. Control group included 80 patients who underwent the suturing of the ulcer using classic two-row technique. Endoscopy was performed after 9 or 10 days and after 3 to 72 months.
Results. Fibrogastroduodenoscopy performed at day 10 after the surgery revealed significant differences in ulcer healing rate. Red scars were identified in 41 study group patients (52%) and 38 controls (27.5%) (c2=3.86, p=0.0001). Scar shape has also demonstrated significant differences, i.e., the scar was linear in most study group patients (n=66, 83.5%) and stellar in controls (n=62, 77.5%) (c2=47.23, p=0.001). Accelerated healing of the ulcer in the study group and more significant inflammation in the controls were confirmed by ultrasound.
Conclusions. Running two-level suturing technique is characterized by various advantages, i.e., (1) precise approximation of gastric walls due to the suturing technique which provides layer-by-layer wound healing; (2) minimal compression of intramural vessels and microcirculation abnormalities when suturing; (3) the avoidance of the contacts between the sutures and the lumen and the contamination of gastric/duodenal wall internal layers. Wound healing conditions are more favorable due to the uniform suture allocation with every stitch, the abscence of the knots between the levels, and more close approximation of serous membranes at the site of the suturing thus minimizing the risks of microabscesses, local ischemia, and suture cutting through the tissues.

Key words: perforated ulcer, ulcer healing, fibrogastroduodenoscopy.

For citation: Nikitin V.N., Klipach S.G. Running two-level suturing technique for perforated pyloroduodenal ulcers // RMJ. 2016. № 23. P. 1566–1569.